Medical Oncology

, 26:358 | Cite as

Laboratory investigation of hypercoagulability in cancer patients using rotation thrombelastography

  • O. Meltem Akay
  • Zeki Ustuner
  • Zerrin Canturk
  • Fezan Sahin Mutlu
  • Zafer GulbasEmail author
Original Paper


The goal of this study was laboratory testing for hypercoagulability in patients with solid tumors using rotation thrombelastogram (ROTEM®) and correlate ROTEM® parameters with routine coagulation tests. A total of 78 untreated patients with cancer were included: 28 gastrointestinal system tumors (group 1), 27 respiratory system tumors (group 2), and 23 miscellaneus group of ovarian, renal, nasopharyngeal, mesothelioma, and unknown origin (group 3). Platelet count was significantly increased in group 2 in respect to group 3 (P < 0.05) and fibrinogen level was significantly increased in group 2 in respect to group 1 (P < 0.05). There was no statistically significant difference between subgroups in respect to TEG parameters. Tumor-node-metastasis (TNM) stages of patients was not also associated with either of TEG parameters. Correlation analysis revealed significant correlation between laboratory parameters and ROTEM® parameters. Fibrinogen showed the strongest correlation with MCF (r > 0.7) and CFT in all assays (INTEM, EXTEM, FIBTEM, APTEM). There were also statistically significant correlations between platelet number and other ROTEM® parameters (INTEM-CFT, -MCF, EXTEM-CFT, -MCF, FIBTEM-MCF, APTEM-CFT, -MCF). In conclusions, our data demonstrates thromboelastographic signs of hypercoagulability in patients with solid tumors. ROTEM® is able to identify the contribution of fibrinogen and platelets to clot strength in this patient population.


Thrombelastography Thrombosis Cancer 


  1. 1.
    Troussea A. Phlegmasia alba dolens. In: Peter M, editor. Clinique Medicale de l’Hotel-Dieu de Paris. Paris: Bailliere JB et Fils; 1877. p. 695–739.Google Scholar
  2. 2.
    Nijziel MR, van Oerle R, Hillen HFP, Hamulyak K. From Trousseau to angiogenesis: the link between the hemostatic system and cancer. Neth J Med. 2006;64(11):403–10.PubMedGoogle Scholar
  3. 3.
    Winter PC. The pathogenesis of venous thromboembolism in cancer: emerging links with tumour biology. Hematol Oncol. 2006;24:126–33. doi: 10.1002/hon.785.PubMedCrossRefGoogle Scholar
  4. 4.
    Traverso CI, Caprini JA, Arcelus JI. The normal thromboelastogram and its interpretation. Semin Thromb Hemost. 1995;21(Suppl 4):7–13.PubMedGoogle Scholar
  5. 5.
    Spiel AO, Mayr FB, Firbas C, Ouehenberger P, Jilma B. Validation of rotation thrombelastography in a model of systemic activation of fibrinolysis and coagulation in humans. J Thromb Haemost. 2005;4:411–16. doi: 10.1111/j.1538-7836.2006.01715.x.CrossRefGoogle Scholar
  6. 6.
    Schobersberger W, Mittermayr M, Fries D, Innerhofer P, Klingler A, et al. Changes in blood coagulation of arm and leg veins during a simulated long-haul flight. Thromb Res. 2007;119:293–300. doi: 10.1016/j.thromres.2006.03.003.PubMedCrossRefGoogle Scholar
  7. 7.
    Sorenson B, Johansen P, Christiansen K, Woelke M, Ingerslev J, et al. Whole blood coagulation thromboelastographic profiles employing minimal tissue factor activation. J Thromb Haemost. 2002;1:551–8. doi: 10.1046/j.1538-7836.2003.00075.x.CrossRefGoogle Scholar
  8. 8.
    Zwicker JI, Furie BC, Furie B. Cancer-associated thrombosis. Clin Rev Oncol Hematol. 2007;62(2):126–36. doi: 10.1016/j.critrevonc.2007.01.001.CrossRefGoogle Scholar
  9. 9.
    Donati MB. Cancer and thrombosis. Haemostasis. 1994;24:128–31.PubMedGoogle Scholar
  10. 10.
    Mallett SV, Cox DJA. Thromboelastography. Br J Anaesth. 1992;69:307–13. doi: 10.1093/bja/69.3.307.PubMedCrossRefGoogle Scholar
  11. 11.
    Cohen E, Caprini JP, Zuckerman L, Vagher P, Robinson B. Evaluation of three methods used to identify accelerated coagulability. Thromb Res. 1977;10:587–604. doi: 10.1016/0049-3848(77)90214-6.PubMedCrossRefGoogle Scholar
  12. 12.
    Arcelus JI, Traverso CI, Caprini JA. Thromboelastography for the assessment of hypercoagulability during general surgery. Semin Thromb Hemost. 1995;2:21–6.Google Scholar
  13. 13.
    Levine M. Treatment of thrombotic disorders in cancer patients. Haemostasis. 1997;27:38–43.PubMedGoogle Scholar
  14. 14.
    Howland WS, Castro EB, Fortner JB, Gould RN. Hypercoagulability, thrombelastographic monitoring during extensive hepatic surgery. Arch Surg. 1974;108:605–8.PubMedGoogle Scholar
  15. 15.
    Butler MJ. Thromboelastography during and after elective abdominal surgery. Thromb Hemost. 1978;39:488–95.Google Scholar
  16. 16.
    Mahla E, Lang T, Vicenzi MN, Werkgartner G, Maier R, et al. Thromboelastography for monitoring prolonged hypercoagulability after major abdominal surgery. Anesth Analg. 2001;92:572–7. doi: 10.1097/00000539-200103000-00004.PubMedCrossRefGoogle Scholar
  17. 17.
    Goh KUC, Tsio WC. Hemostatic changes during surgery for primary brain tumors. J Neurol Neurosurg Psychiatry. 1997;63:334–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Artang R, Jensen E, Pedersen F, Frandsen NJ. Thrombelastography in healthy volunteers, patients with stable angina and acute chest pain. Thromb Res. 2000;97:499–503. doi: 10.1016/S0049-3848(99)00210-8.PubMedCrossRefGoogle Scholar
  19. 19.
    Holloway DS, Vagher JP, Caprini JA, Simon NM, Mockros LF. Thromboelastography of blood from subjects with chronic renal failure. Thromb Res. 1987;45:817–25. doi: 10.1016/0049-3848(87)90091-0.PubMedCrossRefGoogle Scholar
  20. 20.
    Spillert CR, McGovern PJ, Vidaver RM, Lazaro EJ. Thrombelastographic evaluation of cut-down induced accelerated coagulation. Thromb Hemost. 1981;46:567.Google Scholar
  21. 21.
    Fisch IR, Freedman SH. Oral contraceptives, ABO blood groups, and in vitro fibrin formation. Obstet Gynecol. 1975;46(4):473–9.PubMedGoogle Scholar
  22. 22.
    Parvez Z, Moncada R, Fareed J, Messmore HL. Effect of non-ionic contrast media on the components of coagulation and complement systems. Invest Radiol. 1983;18:279–84. doi: 10.1097/00004424-198305000-00012.PubMedCrossRefGoogle Scholar
  23. 23.
    Caprini JA, Zuckerman L, Cohen A, Vagher JP, Lipp V. The identification of accelerated coagulability. Thromb Res. 1976;9:167–80. doi: 10.1016/0049-3848(76)90161-4.PubMedCrossRefGoogle Scholar
  24. 24.
    Francis JL, Francis DA, Gunathilagan GJ. Assessment of hypercoagulability in patients with cancer using the Sonoclot AnalyzerTM and Thrombelastography. Thromb Res. 1994;74:335–46. doi: 10.1016/0049-3848(94)90149-X.PubMedCrossRefGoogle Scholar
  25. 25.
    Sun NC, McAfee WM, Hum GJ, Weiner JM. Hemostatic abnormalities in malignancy, a prospective study in one hundred eight patients. Part I. Coagulation study. Am J Clin Pathol. 1979;71:10–6.PubMedGoogle Scholar
  26. 26.
    Edwards RL, Rickles FR, Moritz TE, Henderson WG, Zacharski LR, et al. Abnormalities of blood coagulation tests in patients with cancer. Am J Clin Pathol. 1987;88:596–602.PubMedGoogle Scholar
  27. 27.
    Kettner SC, Panzer OP, Kozek SA, Seibt FA, Stoiser B, et al. Use of abciximab-modified thrombelastography in patients undergoing cardiac surgery. Anesth Analg. 1999;89:580–4. doi: 10.1097/00000539-199909000-00007.PubMedCrossRefGoogle Scholar
  28. 28.
    Khurana S, Mattson JC, Westley S, O’Neill WW, Timmis GC, et al. Monitoring platelet glycoprotein IIb/IIIa-fibrin interaction with tissue factor-activated thrombelastography. J Lab Clin Med. 1997;130:401–11. doi: 10.1016/S0022-2143(97)90040-8.PubMedCrossRefGoogle Scholar
  29. 29.
    Nielsen VG, Geary BT, Baird MS. Evaluation of the contribution of platelets to clot strength by thrombelastography in rabbits: the role of tissue factor and cytochalasin D. Anaesth Analg. 2000;91:35–9. doi: 10.1097/00000539-200007000-00007.CrossRefGoogle Scholar
  30. 30.
    Zuckerman L, Cohen E, Vagher JO, Woodwart E, Caprini JA. Comparison of thrombelastography with common coagulation tests. Thromb Haemost. 1981;46:752–6.PubMedGoogle Scholar
  31. 31.
    Björgell O, Robertson F. Scoring systems for grading deep leg vein thrombosis. Acta Radiol. 2002;43:299–305. doi: 10.1034/j.1600-0455.2002.430311.x.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2008

Authors and Affiliations

  • O. Meltem Akay
    • 1
  • Zeki Ustuner
    • 2
  • Zerrin Canturk
    • 1
  • Fezan Sahin Mutlu
    • 3
  • Zafer Gulbas
    • 1
    Email author
  1. 1.Department of HematologyEskisehir Osmangazi University Medical SchoolEskisehirTurkey
  2. 2.Department of Medical OncologyEskisehir Osmangazi University Medical SchoolEskisehirTurkey
  3. 3.Department of BiostatisticsEskisehir Osmangazi University Medical SchoolEskisehirTurkey

Personalised recommendations