Follow-Up of Thrombin Generation after Prostate Cancer Surgery: Global Test for Increased Hypercoagulability

Abstract

Recent studies provided evidence that evaluation of thrombin generation identifies patients at thrombotic risk. Thrombin generation has a central role in hemorrhage control and vascular occlusion and its measurement provides new metrics of these processes providing sufficient evaluation of an individual’s hemostatic competence and response to anticoagulant therapy. The objective of the study is to assess a new measure of hypercoagulability that predisposes to venous thromboembolism in the postoperative period after radical prostatectomy. Pre- (day-1) and postoperative (hour 1, day 6, month 1 and 10) blood samples of 24 patients were tested for plasma thrombin generation (peak thrombin), routine hematology and hemostasis. Patients received low molecular weight heparin for thromboprophylaxis. Peak thrombin levels were higher in patients compared to controls at baseline (p<0.001), and elevated further in the early postoperative period (p<0.001). Longer general anesthesia and high body mass index were associated with increased thrombin generation after surgery (p = 0.024 and p = 0.040). D dimer and fibrinogen levels were higher after radical prostatectomy (p = 0.001 and p<0.001). Conventional clotting tests remained within the reference range. Our study contributed to the cognition of the hypercoagulable state in cancer patients undergoing pelvic surgery and revealed the course of thrombin generation after radical prostatectomy. Whilst it is unsurprising that thrombin generation increases after tissue trauma, further evaluation of this condition during the postoperative period would lead urologists to an international and well-supported consensus regarding thromboprophylaxis in order to provide better clinical outcome. Considering the routine evaluation of procoagulant activity and extending prophylactic anticoagulant therapy accordingly may potentially prevent late thrombotic events.

From laboratory to clinical practice: Dabigatran effects on thrombin generation and coagulation in patient samples

“…Thus, Dabi might be less effective than anticipated in thrombogenic situations. States with enhanced thrombin generation, such as the antiphospholipid syndrome, cancer, and ongoing thrombosis may compromise the efficacy of Dabi [31][32][33].…”

Present Practice of Thrombosis Prophylaxis of Radical Prostatectomy in a European Country: A Hungarian Multicenter Study

“…LMWH administration was stopped before the end of the 2nd week in almost 20% of the patients. According to different studies the risk of thrombotic events remains till at least the end of the 1st postoperative month [2,10]. The role of different ways of mechanic prophylaxis was minor except the early mobilization.…”

“…The hypercoagulable state after RP was proven by a recent trial which can be a predictor of thrombotic events [10]. Since the second peak of thrombotic events is present in the 4th week after radical pelvic surgery, use of the prophylactic method should be considered till the end of the 1st postoperative month [2].…”

Evaluation of D-dimer and lactate dehydrogenase plasma levels in patients with relapsed acute leukemia

“…A better understanding of AL relapse and the careful monitoring of clinical parameters following chemotherapy may aid clinicians in determining the best treatment options on an individual patient basis. As a result of local activation of intravascular coagulation at the onset of some forms of malignancy (13,14), the fibrinolytic marker D-dimer increases and accumulates (14). LDH exists in numerous cell systems and, subsequent to tissue or cell damage, serum LDH levels may increase (15).…”