Prediction of Venous Thromboembolism in Patients With Cancer by Measuring Thrombin Generation: Results From the Vienna Cancer and Thrombosis Study

Ay, Cihan; Dunkler, Daniela; Simanek, Ralph; Thaler, Johannes; Koder, Silvia; Marosi, Christine; Zielinski, Christoph; Pabinger, Ingrid

doi:10.1200/jco.2010.32.8294

Cited by 197 publications

(182 citation statements)

References 31 publications

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“…In the last years, clinical research on prediction of cancer-associated VTE has focused on clinical and laboratory parameters. [8][9][10][11][12][13][14] Based on laboratory and clinical parameters associated with VTE, a scoring model for the prediction of VTE in cancer patients was recently developed 15 and has already been expanded 16 and validated 17 in other study populations. However, given the heterogeneity of cancer patients, improved predictability and better understanding of the underlying pathomechanisms of cancer-associated VTE are desirable.…”

Section: Introductionmentioning

confidence: 99%

Regional lymph node metastases are a strong risk factor for venous thromboembolism: results from the Vienna Cancer and Thrombosis Study

Dickmann

Ahlbrecht

et al. 2013

Haematologica

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Section: Introductionmentioning

confidence: 99%

Regional lymph node metastases are a strong risk factor for venous thromboembolism: results from the Vienna Cancer and Thrombosis Study

Dickmann

Ahlbrecht

et al. 2013

Haematologica

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“…79 Thrombin formation has a key role in the hypercoagulable state of malignancies. The CAT study 80 showed that patients with elevated peak thrombin levels (!611 nM) had an increased VTE risk (HR, 2.1; 95% CI, 1.3-3.3; P ¼ .002) and higher cumulative probability of VTE after 6 months compared with those with low levels (11% versus 4%; P ¼ .002). Thus, thrombin measurement may help identify cancer patients at high VTE risk.…”

Section: Biologic Predictive Markersmentioning

confidence: 99%

“…Thus, thrombin measurement may help identify cancer patients at high VTE risk. 80 Microparticles are small vesicles derived from activated or apoptotic cells, including platelets, monocytes, endothelial cells, and tumor cells, by proteolytic cleavage of cytoskeleton. The procoagulant properties of MPs are attributed to their coagulation components, such as phosphatidylserine and TF.…”

Section: Biologic Predictive Markersmentioning

confidence: 99%

Assessing the Risk and Prognosis of Thrombotic Complications in Cancer Patients

Kyriazi

Theodoulou

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Cancer is characterized by the development of a prothrombotic state. Approximately 15% to 20% and 1.5% to 3.1% of cancer patients develop venous and arterial thrombosis, respectively, whereas 18% to 20% of idiopathic venous events are caused by an occult neoplasia. The highest risk is observed in hematologic, gastrointestinal, and lung malignancies, as well as in patients with active disease, especially in the first 3 months after cancer diagnosis. Hospitalization, surgical interventions, and implanted venous devices increase the thrombotic risk. Patients with metastatic disease, febrile neutropenia, infections, and severe comorbidities experience more frequently a thrombotic event. A contemporary prechemotherapy predictive model incorporates both clinical and biologic parameters, such as the primary cancer site, platelet count, white blood cell count, hemoglobin, use of erythropoietic agents, and body mass index. Several studies aim to clarify the prognostic value of tissue factor, P-selectin, thrombin generation, microparticles, and D-dimers. Objectives.—To summarize current views on epidemiology, risk factors, and predictive variables, discussing the future perspectives and existing limitations in clinical practice. Data Sources.—Review of published literature, including review papers, epidemiologic studies, and clinical trials, in online medical databases. Conclusions.—The thrombogenic properties of tumor cells affect the prognosis and quality of life for the cancer population. Despite the improved awareness and prompt use of thromboprophylaxis, recent studies reported increased rates of thrombotic events, whereas the annual risks for thrombosis recurrence and bleeding are 21% and 12%, respectively. The clinical use of risk factors and prognostic parameters could allow for patient risk stratification and individualization of anticoagulant treatment.

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“…The 804 patients in this analysis were enrolled between October 2003 and March 2008. The exact inclusion and exclusion criteria of CATS were described extensively in previous reports (18,19). Briefly, patients 18 years or older with newly diagnosed malignancy or disease progression after complete or partial remission were recruited after written informed consent and followed-up for 2 years until the occurrence of VTE, death, or censoring alive.…”

Section: Study Population and Designmentioning

confidence: 99%

Soluble Vascular Endothelial Growth Factor (sVEGF) and the Risk of Venous Thromboembolism in Patients with Cancer: Results from the Vienna Cancer and Thrombosis Study (CATS)

Posch

Thaler

Zlabinger

et al. 2016

Clinical Cancer Research

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Purpose: Cancer patients are at an increased risk of venous thromboembolism (VTE). VEGF promotes the growth of highly thrombogenic tumor vessels. Here, we explored the utility of soluble plasma VEGF-A (sVEGF) as a biomarker for the prediction of VTE in patients with cancer.Experimental Design: Eight hundred four patients with newly diagnosed cancer or progression after remission were prospectively followed for 2 years until the occurrence of VTE or death [tumor sites:, myeloma and lymphoma (n ¼ 99), and others (n ¼ 48)]. Primary endpoint was symptomatic or fatal VTE. sVEGF was measured by immunoassay in baseline plasma.Results: Fifty-five patients developed VTE (6.8%) and 364 patients (45.3%) died. Five-hundred and forty-two (68.3%) participants had sVEGF levels above the detection limit of 0.5 pg/mL. The median sVEGF level (25th-75th percentile) was 8.1 pg/mL (0-17.7). The cumulative 2-year incidence of VTE was 10.2% [95% confidence interval (CI), 6.4-14.9] in patients with sVEGF greater than the 75th percentile of the sVEGF distribution (Q3, cutoff: 17.7 pg/mL), and 5.9% (95% CI, 4.2-7.9) in patients with lower levels (P ¼ 0.03). The corresponding 2-year risk of death was 52.8% (95% CI, 46.0-60.0) and 43.9% (95% CI, 40.0-48.0), respectively (P ¼ 0.02). In univariable time-to-VTE regression, elevated sVEGF was associated with VTE [subhazard ratio (SHR) per 10 pg/mL increase, 1.04; 95% CI,1.00-1.09; P ¼ 0.04)]. The association between sVEGF and risk of VTE prevailed after multivariable adjustment for high-risk tumor sites, age, gender, factor VIII, thrombin generation potential, and soluble P-Selectin (adjusted SHR, 1.04; 95% CI, 1.00-1.09, P ¼ 0.05).Conclusions: Elevated sVEGF is associated with an increased risk of VTE in patients with cancer. Clin Cancer Res; 22(1); 200-6. Ó2015 AACR.

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Prediction of Venous Thromboembolism in Patients With Cancer by Measuring Thrombin Generation: Results From the Vienna Cancer and Thrombosis Study

Abstract: Measurement of thrombin generation may help identify patients with cancer at high risk of VTE.

Cited by 197 publications

References 31 publications

Regional lymph node metastases are a strong risk factor for venous thromboembolism: results from the Vienna Cancer and Thrombosis Study

Regional lymph node metastases are a strong risk factor for venous thromboembolism: results from the Vienna Cancer and Thrombosis Study

Assessing the Risk and Prognosis of Thrombotic Complications in Cancer Patients

Soluble Vascular Endothelial Growth Factor (sVEGF) and the Risk of Venous Thromboembolism in Patients with Cancer: Results from the Vienna Cancer and Thrombosis Study (CATS)

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