1
|
Rennebaum S, Schneider SW, Henzler T, Desch A, Weiß C, Haubenreisser H, Goerdt S, Morelli JN, Utikal JS, Schoenberg SO, Riffel J. Incidence of pulmonary embolism and impact on mortality in patients with malignant melanoma. Clin Imaging 2021; 83:72-76. [PMID: 34990983 DOI: 10.1016/j.clinimag.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/02/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Pulmonary embolism (PE) occurs frequently in patients with malignant melanoma (MM). The aim of this study is to determine the incidence of PE in patients with MM and to assess the clinical characteristics and mortality of MM patients with PE. MATERIAL AND METHODS Medical records from 381 MM patients who underwent contrast-enhanced computed tomography were evaluated. Imaging parameters including location of PE and measurements of right heart dysfunction and clinical parameters including D-Dimer levels, local and distant tumor stage and time of death were analyzed. RESULTS PE was found in 23/381 (6%) MM patients, whereby 17/23 (74%) were detected incidentally and only 6/23 (26%) were symptomatic. The presence of PE significantly correlated with elevated D-Dimers (p < 0.001), right ventricular dysfunction (p = 0.04), higher local tumor stage (≥T3) (p = 0.05), presence of visceral (p = 0.02) or cerebral metastases (p = 0.03) and increased mortality (p = 0.05). Further, patients with central PE showed an increased mortality compared to peripheral PE (p = 0.03), but no correlation was found between the localization of PE and the occurrence of clinical symptoms (p = 0.36). CONCLUSION PE in patients with MM often occurs without clinical symptoms and is indicative for advanced disease and a poorer prognosis.
Collapse
Affiliation(s)
- Shereen Rennebaum
- Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Stefan W Schneider
- University Hospital of Hamburg-Eppendorf, Clinic of Dermatology, Hamburg, Germany
| | - Thomas Henzler
- Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Anna Desch
- University Medical Center Mainz, Department of Dermatology, Venereology and Allergology, Germany
| | - Christel Weiß
- University of Heidelberg, Medical Statistics, Mannheim, Germany
| | - Holger Haubenreisser
- Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Sergij Goerdt
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - John N Morelli
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jochen S Utikal
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Stefan O Schoenberg
- Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim, Germany
| | - Julia Riffel
- Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim, Germany.
| |
Collapse
|
2
|
Siddiqui F, Antic D, Tafur A, Bontekoe E, Hoppensteadt D, Gerotziafas G, Elalamy I, Fareed J. Thrombin Generation Profile in Various Lymphoma Sub-Groups and Its Augmentation by Andexanet Alfa. Clin Appl Thromb Hemost 2021; 26:1076029620983466. [PMID: 33372544 PMCID: PMC7783880 DOI: 10.1177/1076029620983466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The prevalence of thrombosis in lymphoma patients is reportedly high and ranges
from 3-10%. Vascular malfunction and inflammatory processes further contribute
to the thrombotic activation process in these patients. Andexanet alfa (AA) is
an antidote for factor Xa inhibitors and its usage has been reported with
thrombotic complications. This study was designed to compare the effect of AA on
the thrombin generation (TG) potential. Blood samples from 78 patients with
confirmed diagnosis of non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL) and
Chronic lymphocytic leukemia (CLL) were collected from the University of
Belgrade Clinic, Serbia. Normal human plasma (NHP) was used for referencing
purposes. Individual samples were supplemented with AA at 100 ug/ml. TG studies
were carried out using a commercially available fluorogenic substrate method. TG
parameters such as peak thrombin (PT), lag time (LT) and area under the curve
(AUC) were compiled. Cumulatively, lymphoma patients showed an increase in LT
compared to NHP which decreases with AA. The PT and AUC levels were decreased
compared to NHP and increases with AA. Upon sub-grouping of lymphoma patients,
PT levels for all sub-groups were increased with AA. The AUC values increased
for HL and NHL and decreased for CLL with AA. Variations in lag time were noted
in all 3 sub-groups. Lymphoma represents a heterogenous group of patients where
both the hypercoagulable state and inflammatory responses simultaneously occur.
Increased thrombin generation in post AA supplemented samples suggest that the
use of this agent may potentially be associated with thrombotic
complications.
Collapse
Affiliation(s)
- Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Darko Antic
- Head of Intensive care unit, Lymphoma Centre, Clinic for Hematology, Clinical Center Serbia, University of Belgrade, Belgrade, Serbia.,Department of Internal Medicine, University of Belgrade, Belgrade, Serbia
| | - Alfonso Tafur
- Northshore Cardiovascular Institute, NorthShore University Health Systems, Skokie, IL, USA
| | - Emily Bontekoe
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine and Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Grigoris Gerotziafas
- Head of Thrombosis and Haemostasis Unit, Co-Chair of Thrombosis Center, Service d'Hématologie Biologique, Tenon, University Hospital, France.,Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, INSERM U938 and Université Pierre et Marie Curie, Paris, France
| | - Ismail Elalamy
- Service d'Hématologie Biologique, Hôpital Tenon UPMC EA3499, Paris, France
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine and Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| |
Collapse
|
3
|
von Tempelhoff GF, Heilmann L, Pollow K, Hommel G. Monitoring of Rheologic Variables During Postoperative High-Dose Brachytherapy for Uterine Cancer. Clin Appl Thromb Hemost 2016; 10:239-48. [PMID: 15247981 DOI: 10.1177/107602960401000306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Oxygenation of tumor tissue has recently been assed an important prerequisite for the effectiveness of radiotherapy in cervical cancer. Hyperviscosity is a common phenomenon in malignancy and a cause of reduced oxygen transport capacity that would favour tissue hypoxia. Hemorheological variables were serially tested preoperatively, during four cycles of fractionated adjuvant IR192 HDR after loading radiation (HDR-AL) of the vaginal vault (weekly intervals), and 6 months postoperatively in patients with cervical (n=12) and endometrial cancer (n=26). Women who were scheduled for benign tumor surgery served as controls (n=29). Preoperatively, in cervical and endometrial cancer patients, mean plasma viscosity (PV: 1.31±0.1 mPa s; p<0.05; 1.35±0.13 mPa s; p<0.001) and fibrinogen levels (383±46 mg/dL; p<0.05; 379±117 mg/dL; p<0.05) were higher as compared to the controls (1.25±0.07 mPa s; 314±89 mg/dL). Red blood cell aggregation at low shear and stasis (RBC agg.: 15.7±5.6; p<0.05; 29.6±9.1; p<0.05) was higher in endome-trial cancer patients as compared to the controls (13.7±3.4; 25.3±5.6). Postoperatively PV decreased in endometrial cancer patients and transiently increased in cervical cancer patients. After the third session of irradiation in both cancer groups, PV regained and at the 6-month checkup, levels were higher as compared to the values before surgery. Postoperatively fibrinogen levels increased and remained higher throughout HDR-AL and 6 months postoperatively. After surgery and during irradiation, anemia persisted in both cancer groups while hematocrit recovered after 6 months in endometrial cancer patients. Thrombosis was diagnosed in three patients postoperatively (7.9%) but in none during HDR-AL. While a temporary reduction of hyperviscosity is found postoperatively and during HDRAL in uterine cancer patients, 6 months after surgery RBC aggregation, PV, and hematocrit returned to the pretreatment range.
Collapse
|
4
|
Kawano N, Yamaguchi K, Niki T, Yamamoto T, Iwase T, Taketani Y, Ise T, Yamada H, Soeki T, Wakatsuki T, Kawano K, Kakutani A, Sata M. Two cases of acute myocardial infarction during combined chemotherapy in young patients with testicular cancer. J Cardiol Cases 2013; 7:e176-e180. [PMID: 30533157 DOI: 10.1016/j.jccase.2013.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 02/12/2013] [Accepted: 02/20/2013] [Indexed: 10/27/2022] Open
Abstract
The two patients were males aged over 30 years. To treat testicular tumors, combination chemotherapy with bleomycin, etoposide, and cisplatin (BEP) had been employed. In case 1, during the 4th course of BEP therapy, thoracic pain suddenly appeared. Emergency coronary angiography revealed thrombus formation. Under a diagnosis of thrombus-related acute myocardial infarction, thrombus aspiration was conducted, and stent implantation was performed because mild stenosis and residual thrombus were observed. In case 2, during the 2nd course of BEP therapy, thoracic pain suddenly appeared. Emergency coronary angiography revealed thrombus formation. Intracoronary infusion of pro-urokinase was performed, and additional balloon dilatation was conducted because mild stenosis and residual thrombus were observed. In both cases, the courses were favorable, and the levels of coagulation markers on admission were high. When selecting combination chemotherapy in patients with coronary risk factors, such as obesity and smoking, despite a young age, as demonstrated in these two patients, it may be important to consider combination therapy with anticoagulants or switching to anticancer drugs that do not show vascular toxicity. <Learning objective: When performing combination chemotherapy with bleomycin, etoposide, and cisplatin in young patients with coronary risk factors such as obesity and smoking, it may be important to examine combination therapy with anticoagulants or switching to anticancer drugs that do not show vascular toxicity, considering the possibility of cardiovascular disease onset, including acute myocardial infarction.>.
Collapse
Affiliation(s)
- Naoko Kawano
- The Post-Graduate Education Center, Tokushima University Hospital, Tokushima, Japan
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Toshiyuki Niki
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Takashi Yamamoto
- Department of Internal Medicine, Tokushima Kouseiren Oe Kyodo Hospital, Yoshinogawa, Japan
| | - Takashi Iwase
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Yoshio Taketani
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Kazuhiro Kawano
- Department of Internal Medicine, Tokushima Kouseiren Oe Kyodo Hospital, Yoshinogawa, Japan
| | - Akiyoshi Kakutani
- Department of Internal Medicine, Tokushima Kouseiren Oe Kyodo Hospital, Yoshinogawa, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| |
Collapse
|
5
|
Amirkhosravi A, Mousa SA, Amaya M, Meyer T, Davila M, Robson T, Francis JL. Assessment of anti-metastatic effects of anticoagulant and antiplatelet agents using animal models of experimental lung metastasis. Methods Mol Biol 2010; 663:241-259. [PMID: 20617422 DOI: 10.1007/978-1-60761-803-4_10] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
It is well established that the blood coagulation system is activated in cancer. In addition, there is considerable evidence to suggest that clotting activation plays an important role in the biology of malignant tumors, including the process of blood-borne metastasis. For many years our laboratory has used experimental models of lung metastasis to study the events that follow the introduction of procoagulant-bearing tumor cells into circulating blood. This chapter focuses on the basic methods involved in assessing the anti-metastatic effects of anticoagulants and anti-platelet agents using rodent models of experimental metastasis. In addition, it summarizes our experience with these models, which collectively suggests that intravascular coagulation and platelet activation are a necessary prelude to lung tumor formation and that interruption of coagulation pathways or platelet aggregation may be an effective anti-metastatic strategy.
Collapse
Affiliation(s)
- Ali Amirkhosravi
- Florida Hospital Center for Thrombosis Research, Orlando, FL, USA
| | | | | | | | | | | | | |
Collapse
|
6
|
Kuderer NM, Ortel TL, Francis CW. Impact of venous thromboembolism and anticoagulation on cancer and cancer survival. J Clin Oncol 2009; 27:4902-11. [PMID: 19738120 DOI: 10.1200/jco.2009.22.4584] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Changes in the hemostatic system and chronic hemostatic activation are frequently observed in patients with cancer, even in the absence of venous thromboembolism (VTE). VTE is a leading cause of death among patients with cancer and contributes to long-term mortality in patients with early as well as advanced-stage cancer. Mounting evidence suggests that components of the clotting cascade and associated vascular factors play an integral part in tumor progression, invasion, angiogenesis, and metastasis formation. Furthermore, there are intriguing in vitro and animal findings that anticoagulants, in particular the low molecular weight heparins (LMWHs), exert an antineoplastic effect through multiple mechanisms, including interference with tumor cell adhesion, invasion, metastasis formation, angiogenesis, and the immune system. Several relatively small randomized controlled clinical trials of anticoagulation as cancer therapy in patients without a VTE diagnosis have been completed. These comprise studies with LMWH, unfractionated heparin, and vitamin K antagonists, with overall encouraging but nonconclusive results and some limitations. Meta-analyses performed for the American Society of Clinical Oncology VTE Guidelines Committee and the Cochrane Collaboration suggest overall favorable effects of anticoagulation on survival of patients with cancer, mainly with LMWH. However, definitive clinical trials have been elusive and questions remain regarding the importance of tumor type and stage on treatment efficacy, the impact of fatal thromboembolic events, optimal anticoagulation therapy, and safety with differing chemotherapy regimens. Although the LMWHs and related agents hold promise for improving outcomes in patients with cancer, additional studies of their efficacy and safety in this setting are needed.
Collapse
Affiliation(s)
- Nicole M Kuderer
- Division of Hematology, Oncology and Cellular Therapy, Duke Comprehensive Cancer Center, Duke University Medical Center, DUMC 3841, Durham, NC 27710, USA.
| | | | | |
Collapse
|
7
|
[Case of brain infarction during cisplatin-based combined chemotherapy with bleomycin, etoposide and cisplatin for testicular cancer]. Nihon Hinyokika Gakkai Zasshi 2009; 100:12-5. [PMID: 19198224 DOI: 10.5980/jpnjurol.100.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 31-year-oldman presented with a 6-month history of right testicular enlargement. The patient underwent a right inguinal orchiectomy. Histopathological examination showed nonseminomatous germ cell tumor (choriocarcinoma>seminoma) which was confined to the tunica albuginea. The postoperative serum level of alpha-fetoprotein (AFP) and lactate dehydrogenase were normal. Serum level of human chorionic gonadotrophin(HCG), however, was 23,000 mIU/ml (normal, < 0.7 mIU/ml). A thoracic computed tomography (CT) at that time showed bilateral and multiple metastases to the lungs but the abdominal CT was normal. After the surgery, the patient was treated with conventional doses of cisplatin, etoposide, and bleomycin. On day 11 of the second chemotherapy course, the patient developed confusion and right sided weakness. Brain magnetic resonance imaging (MRI) showed an ischemic lesion in the left middle cerebral artery area. An echocardiogram showed normal left ventricular function and no valvular vegetations. Finally, the patient completed one additional course of chemotherapy with considerable measures to prevent side effects. A thoracic CT at the end of the third cycle showed no evidence of tumor. At 3 months followup after chemotherapy, he suffered from partial paralysis of right-sided upper and lower limbs but due to intensive rehabilitation he overcame the paralysis and is able to walk by himself. There was no evidence of tumor recurrence.
Collapse
|
8
|
|
9
|
López-Gómez M, Gómez-Raposo C, Sereno Moyano M, Casado-Sáenz E, Feliú Batlle J, Ortega Ruipérez C, González Barón M. Idiopathic and recurrent thromboembolic phenomena in cancer patients. Clin Transl Oncol 2008; 10:665-9. [DOI: 10.1007/s12094-008-0268-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
10
|
Bergqvist D, Caprini JA, Dotsenko O, Kakkar AK, Mishra RG, Wakefield TW. Venous Thromboembolism and Cancer. Curr Probl Surg 2007; 44:157-216. [PMID: 17437761 DOI: 10.1067/j.cpsurg.2007.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- David Bergqvist
- Uppsala University Hospital, Department of Surgical Sciences, Uppsala, Sweden
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
Patients with malignancies often experience acute disorders of coagulation. They may manifest as thromboembolism, disseminated intravascular coagulation or a tendency to bleed. Either disorder carries a high rate of complications and a difficult task in diagnosing and treating them. Some complications typical for patients with malignancies are discussed. Among these are tumor associated thrombophilia, acquired von Willebrand's disease, and thrombocytopenia.
Collapse
|
12
|
Pickering W, Gray E, Goodall AH, Ran S, Thorpe PE, Barrowcliffe TW. Characterization of the cell-surface procoagulant activity of T-lymphoblastoid cell lines. J Thromb Haemost 2004; 2:459-67. [PMID: 15009464 DOI: 10.1111/j.1538-7836.2004.00607.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The procoagulant activity (PCA) of four T-lymphoblastoid cell lines (CEM-CCRF, Jurkat, Molt-4 and A3.01) at different stages of differentiation has been characterized and compared with that of a monocytoid cell line (THP-1). Four assay systems were employed; the activated partial thromboplastin time (APTT); prothrombin time/tissue factor (TF) activity; a purified factor (F)Xa generation system and cancer procoagulant. High levels of TF activity were seen only with the monocytic cells. However the more differentiated of the T-lymphoblastoid cells (Molt-4 and A3.01) were more active than monocytic cells in supporting FXa generation. This pattern was not repeated for the APTT assay, which was related to cell-surface TF activity, since it was partially inhibited by antiTF antibody. Annexin V totally inhibited the activity observed in all three assay systems, indicating that the PCA of T-lymphoblastoid cells is primarily due to expression of negatively charged phospholipids. However, antiphosphatidylserine antibody even at a high concentration gave only partial inhibition of the activity observed in the APTT and FXa generation systems for the cells compared with almost total inhibition for the phospholipid standard, suggesting either that cellular phosphatidylserine (PS) is less accessible to the antibody, or that PS is not the sole negatively charged phospholipid responsible for this activity. Flow cytometry studies using propidium iodide and annexin V showed that the PCA, although linked to PS exposure, was not the result of apoptosis.
Collapse
Affiliation(s)
- W Pickering
- Division of Haematology, National Institute for Biological Standards and Control (NIBSC), Potters Bar, UK.
| | | | | | | | | | | |
Collapse
|
13
|
Goldenberg N, Kahn SR, Solymoss S. Markers of Coagulation and Angiogenesis in Cancer-Associated Venous Thromboembolism. J Clin Oncol 2003; 21:4194-9. [PMID: 14615447 DOI: 10.1200/jco.2003.05.165] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose: We sought to determine whether venous thromboembolism in cancer patients is associated with aberrant plasma levels of hemostatic and angiogenic factors. Patients and Methods: Peripheral blood was collected before anticoagulant therapy from cancer patients with acute deep venous thrombosis (DVT; DVT + cancer group, n = 32), those without DVT (cancer control group, n = 36), and patients with acute DVT but no cancer (DVT control group, n = 58). Plasma assays of activation and inhibition of coagulation and fibrinolysis, as well as angiogenesis activation, were then performed. Results: Median levels of thrombin-antithrombin complex, prothrombin fragments 1 + 2, and von Willebrand factor antigen were significantly greater in the DVT + cancer group than in the cancer control and DVT control groups (17.8 ng/mL v 4.6 ng/mL and 9.8 ng/mL, P = .0001 and P = .003, respectively; 3.65 nmol/L v 1.60 nmol/L and 2.71 nmol/L, P < .0001 and P = .011, respectively; and 4.04 U/mL v 2.26 U/mL and 2.06 U/mL, P < .0001, respectively). Median levels of tissue-type plasminogen activator were also significantly higher, while protein C activity was lower in the DVT + cancer group than in the DVT control group (14.6 ng/mL v 9.50 ng/mL, respectively, P = .0005; 0.89 U/mL v 1.11 U/mL, respectively, P = .0008). Conclusion: These data not only support prior observations of coagulation activation in patients with malignancy, but also provide new evidence for enhanced coagulation activation in the setting of acute venous thromboembolism in cancer. Future prospective studies are warranted to determine whether these and other potential markers of hypercoagulability may help to identify cancer patients at highest risk for venous thromboembolism.
Collapse
Affiliation(s)
- Neil Goldenberg
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA.
| | | | | |
Collapse
|
14
|
Sutherland DE, Weitz IC, Liebman HA. Thromboembolic complications of cancer: epidemiology, pathogenesis, diagnosis, and treatment. Am J Hematol 2003; 72:43-52. [PMID: 12508268 DOI: 10.1002/ajh.10263] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The association between malignancy and clinical thrombosis has been recognized for nearly 140 years. The purpose of this review is to examine our current understanding of thrombosis as a complication of cancer and cancer therapy. The review includes a discussion of the epidemiology, pathophysiology, diagnosis and treatment.
Collapse
Affiliation(s)
- Douglas E Sutherland
- Division of Hematology, Department of Medicine, University of Southern California-Keck School of Medicine, Los Angeles, California 90033, USA
| | | | | |
Collapse
|
15
|
Keller T, Salge U, König H, Dodt J, Heiden M, Seitz R. Tissue factor is the only activator of coagulation in cultured human lung cancer cells. Lung Cancer 2001; 31:171-9. [PMID: 11165396 DOI: 10.1016/s0169-5002(00)00196-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It is a long-known principle that tumour cells tend to exploit the host's physiologic systems in order to get support in terms of, for example, nutrition, growth or metastasis. One of these physiologic systems is the blood coagulation cascade, which has been found activated in many tumour patients. The mechanisms of the activation of coagulation have been assessed in numerous animal and in vitro experiments, and the results appeared to point to several distinct activators. The present study used a large panel of different cultivated human lung cancer cell lines and experimental systems involving normal plasma, plasmas deficient of factors V, VII or X, purified coagulation factors II and X, recombinant tissue factor (TF), and specific inhibitory antibodies against factor VII and TF. The results provide strong evidence that there is no activator of coagulation besides TF in the wide array of lung cancer cells examined. However, this work reveals a striking variability of TF content among the cell lines. This might explain ambiguous results of clinical trials of anticoagulation as an adjunct to antineoplastic therapy in lung cancer. By sensitive diagnostic tools like the plasma thrombin-antithrombin complex levels it might be possible to select patients with activated coagulation, who might benefit from anticoagulation.
Collapse
Affiliation(s)
- T Keller
- Department of Haematology and Transfusion Medicine, Paul-Ehrlich-Institut, Paul-Ehrlich-Strasse 51-59, D-63225 Langen, Germany
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
Cancer cells can contribute to activation of the clotting system by their capacity to produce and release procoagulant/fibrinolytic substances and inflammatory cytokines, and by their interaction with host cells (endothelial, monocytes, platelets, and neutrophils). Moreover, anticancer drugs (chemotherapy/hormone therapy) may greatly affect the risk of thromboembolic complications in cancer patients by similar mechanisms, eg, through the release of procoagulants by tumor cells, through endothelial damage, or stimulation of tissue factor production by host cells. The interactions between cancer/metastatic processes and thrombosis have been reviewed here from the pathogenetic viewpoint. We hope that better knowledge of these pathogenetic pathways will lead to the development of more targeted strategies to prevent thromboembolism in cancer patients.
Collapse
Affiliation(s)
- A Falanga
- Hematology Division, Ospedali Riuniti, Bergamo, Italy
| | | |
Collapse
|
17
|
Mielicki WP, Tenderenda M, Rutkowski P, Chojnowski K. Activation of blood coagulation and the activity of cancer procoagulant (EC 3.4.22.26) in breast cancer patients. Cancer Lett 1999; 146:61-6. [PMID: 10656610 DOI: 10.1016/s0304-3835(99)00230-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The activity of cancer procoagulant (CP), prothrombin time (PT), activated partial thromboplastin time (APTT), the concentration of thrombin-antithrombin complexes (TAT) and the concentration of fibrinogen were analysed in blood of breast cancer patients scheduled for surgery. The serum level of CP activity was dependent on the stage of the disease. The CP activity was increased in 72% of patients with an early stage of cancer and in only 20% of patients with an advanced stage of the disease when compared to the baseline level for non-cancer controls. In all patients PT remained at normal levels (80-120%). There was no significant change in APTT (27-39 s) in early stage cancer patients. Only one patient with advanced cancer had APTT shortened to 23 s. Also one advanced stage patient had significantly elevated level of TAT (14.96 microg/l); in all other patients the concentration of TAT remained at normal levels (1-4.1 microg/l). Forty-four percent of early stage cancer patients and 22% of advanced cancer patients had an elevated level of fibrinogen (Fg) ( > 350 mg%). However, there was no correlation between the level of Fg and the CP activity (P > 0.05). The data suggest that: (1) serum CP activity increases at the early stage of breast cancer and decreases down to the normal level in the advanced stage of the disease; (2) there is no evidence of blood clotting activation in the early stage breast cancer patients; and (3) CP does not facilitate the activation of coagulation in the breast cancer patients or the level of such activation is below the sensitivity of assays used in the experiment.
Collapse
Affiliation(s)
- W P Mielicki
- Department of Biochemistry, Medical University of Lodz, Institute of Environmental Research and Bioanalysis, Poland.
| | | | | | | |
Collapse
|
18
|
Cejna M, Thurnher S, Pidlich J, Kaserer K, Schoder M, Lammer J. Primary implantation of polyester-covered stent-grafts for transjugular intrahepatic portosystemic stent shunts (TIPSS): A pilot study. Cardiovasc Intervent Radiol 1999; 22:305-10. [PMID: 10415220 DOI: 10.1007/s002709900393] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate whether placement of a polyester-covered stent-graft increases the primary patency of transjugular intrahepatic portosystemic stent shunts (TIPSS). METHODS Between 1995 and 1997 Cragg Endopro or Passager MIBS stent-grafts were used for the creation of TIPSS in eight male patients, 35-59 years of age (mean 48 years). All patients suffered from recurrent variceal bleeding and/or refractory ascites due to liver cirrhosis. Seven stent-grafts were dilated to a diameter of 10 mm, one to 12 mm. Follow-up was performed with duplex ultrasound, clinical assessment, and angiography. RESULTS The technical success rate for creation of a TIPSS was 100%. The mean portosystemic pressure gradient decreased from 25 mmHg to 12 mmHg. In seven of eight patients TIPSS dysfunction occurred between 2 days and 3 years after stent-graft placement. In one patient the TIPSS is still primarily patent (224 days after creation). The secondary patency rates are 31 days to 3 years. CONCLUSION The primary use of polyester-covered stent-grafts for TIPSS did not increase primary patency rates in our small series.
Collapse
Affiliation(s)
- M Cejna
- Department of Angiography and Interventional Radiology, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | | | | | | | | | | |
Collapse
|
19
|
von Tempelhoff GF, Pollow K, Schneider D, Heilmann L. Chemotherapy and thrombosis in gynecologic malignancy. Clin Appl Thromb Hemost 1999; 5:92-104. [PMID: 10725988 DOI: 10.1177/107602969900500204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Thromboembolism is a severe and frequent problem in gynecologic malignancy. The average DVT incidence during chemotherapy of 5% might represent the lower range of incidence because < 55% of thrombotic complication manifest clinical signs. However, it seems likely that in addition to chemotherapy other risk factors such as menopausal status, BMI of patients, or type of preceding surgery must coincide before thrombosis manifests. While monitoring of patients using sophisticated coagulation tests did not identify patients' risk for DVT during chemotherapy, an evaluation of the coagulation status before initiating chemotherapy is recommended. Patients with a venous access device (e.g., indwelling central venous catheter or with port cart) are at a particularly high risk for DVT. This has to be considered when cytoreductive therapy is given. Thrombosis prophylaxis, orally or subcutaneously, should only be considered in a subpopulation of patients who offer a combination of the aforementioned risk factors. Thrombosis prevention trials during chemotherapy found a significant reduction of DVT in patients treated with anticoagulants.
Collapse
Affiliation(s)
- G F von Tempelhoff
- Department of Obstetrics and Gynecology, City Hospital of Ruesselsheim, Germany
| | | | | | | |
Collapse
|
20
|
Luboshitz J, Bairey O, Blickstein D, Vaknin H, Okon E, Lahav J, Prokocimer M. Cutaneous necrosis as a terminal paraneoplastic thromboembolic event in a patient with non-Hodgkin's lymphoma. J Intern Med 1999; 245:301-5. [PMID: 10205593 DOI: 10.1046/j.1365-2796.1999.00475.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thrombotic complications in non-Hodgkin's lymphoma often originate in the large veins. We describe a patient with refractory advanced high-grade lymphoma who presented with the rare complication of extensive cutaneous necrosis due to thrombosis of dermal vessels; there was also a recent new peak of monoclonal IgM-kappa protein. Direct immunofluorescence demonstrated immune deposits with complement in the dermal vessel wall. Based on these observations and on published data, we suggest that these complexes were the trigger for the thrombotic events and that the monoclonal IgM acted as xenoreactive antibodies, initiating a cascade of events. The first step of this cascade was activation of the complement and the membrane attack complex, which caused secretion of IL-1 alpha by endothelial cells, followed by overexpression of tissue factor on the surface of the dermal vessel wall endothelium. Dermal vessel thrombosis was the final event in this cascade.
Collapse
Affiliation(s)
- J Luboshitz
- Division of Hematology, Rabin Medical Center, Petah-Tikva, Israel
| | | | | | | | | | | | | |
Collapse
|
21
|
Biggerstaff JP, Seth NB, Meyer TV, Amirkhosravi A, Francis JL. Fibrin monomer increases platelet adherence to tumor cells in a flowing system: a possible role in metastasis? Thromb Res 1998; 92:S53-8. [PMID: 9886911 DOI: 10.1016/s0049-3848(98)00161-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Considerable evidence exists linking hemostasis and malignancy. Platelet adhesion to tumor cells has been implicated in the metastatic process. Plasma fibrinogen (Fg) and fibrin (Fn) monomer, increased in cancer, may play a role in tumor biology. Binding of Fn monomer to tumor cells and its effect on platelet-tumor cell adhesion in a flowing system were studied. Fn monomer was produced by adding thrombin (1 micro/mL) to FXIII- and plasminogen-free Fg in the presence of Gly-Pro-Arg-Pro (GPRP) amide. Fn monomer binding to live A375 cells was visualized by confocal laser scanning microscopy (CLSM). Adherent cells were perfused for 1h with Fn monomer, washed and stained in situ with anti-human Fn (American Biogenetic Sciences, Inc.) followed by goat anti-mouse IgG(FITC). Platelet adherence to Fn monomer treated A375 cells was performed under flow conditions by passing platelets (5x10(4)/microl 0.25 mL/min; labeled with the carbocyanine dye DiI) over the tumor cells for 30 min. CLSM images were obtained after washing. There was considerable binding of Fn monomer, but not Fg alone. Platelets adhered relatively weakly to untreated A375 cells and this was not significantly affected by pre-treatment of the tumor cells with fibrinogen or thrombin. However, pre-treatment with Fn monomer resulted in extensive platelet binding to tumor cells, suggesting that coagulation activation and the subsequent increase in circulating Fn monomer may enhance platelet adhesion to circulating tumor cells and thereby facilitate metastatic spread.
Collapse
Affiliation(s)
- J P Biggerstaff
- Hemostasis and Thrombosis Research Unit, Walt Disney Memorial Cancer Institute at Florida Hospital, Orlando 32804, USA
| | | | | | | | | |
Collapse
|
22
|
Suzuki M, Inufusa H, Yamamoto S, Hamada T, Aga M, Ando O, Ohta T, Yasutomi M, Kurimoto M. Le(y) glycolipid acts as a co-factor for tumor procoagulant activity. Int J Cancer 1997; 73:903-9. [PMID: 9399674 DOI: 10.1002/(sici)1097-0215(19971210)73:6<903::aid-ijc24>3.0.co;2-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We have generated a monoclonal antibody (MAb), FS01, which inhibits the procoagulant activity (CCA-1) produced by a human squamous cell carcinoma cell line, LK52. Expression of the antigen recognized by FS01 MAb in various cancer cell lines correlated well with the procoagulant activities of the expressing cell lines. Our objective was to characterize the molecule reacting with FS01 MAb and to analyze its involvement in the CCA-1 procoagulant activity. The molecule was identified as a glycolipid and found to be involved in the procoagulant activity because both procoagulant activity and reactivity to FS01 MAb were lost after endoglycoceramidase treatment of CCA-1. Furthermore, FS01 MAb recognized the Lewis Y (Le[y]) antigen. To confirm the involvement of a glycolipid incorporating the Le(y) antigen in the procoagulant activity, we attempted to purify CCA-1 from LK52 culture supernatant. In one of the purification steps, a fraction containing low procoagulant activity (CCA-1p) separated from the Le(y)-positive fraction (CCA-1c). Although CCA-1c alone did not show procoagulant activity, the procoagulant activity of CCA-1p was augmented by CCA-1c and this augmentation was inhibited by FS01 MAb. Furthermore, CCA-1c enhanced the procoagulant activity of 33 cell lines tested as well as CCA-1p. In addition, purified Le(y) glycolipid from canine intestine augmented the procoagulant activity of CCA-1p, and this augmentation also could be inhibited by FS01 MAb. We conclude that Le(y) glycolipid is a co-factor for the procoagulant activity derived from cancer cells.
Collapse
Affiliation(s)
- M Suzuki
- Fujisaki Institute, Hayashibara Biochemical Laboratories Inc., Okayama, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Bairey O, Gabbay U, Blickstein D, Stark P, Prokocimer M, Epstein O, Shaklai M, Lahav J. Levels of proteins C and S do not decline subsequent to first line chemotherapy in lymphoma patients. Hematol Oncol 1997; 15:121-7. [PMID: 9600111 DOI: 10.1002/(sici)1099-1069(199708)15:3<121::aid-hon606>3.0.co;2-d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thromboembolic complications and decrease in protein C and S have been observed in patients while receiving combination chemotherapy for breast cancer. We investigated whether initial cytotoxic treatment of non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) is also associated with changes in these anticoagulant parameters. For this purpose 25 patients with intermediate to high grade NHL and seven with HD, undergoing primary treatment with cytotoxic drugs were evaluated at three time-points: pre-therapy, mid-therapy and post-therapy. In contrast to the breast cancer patients, no significant changes in protein C, protein S and antithrombin III levels were observed in the NHL patients during the various stages of therapy. However in HD patients, the mean protein C values had a tendency to be higher at mid-therapy compared to pre-therapy and protein S levels had a tendency to be higher at mid-therapy compared to post-therapy. In lymphoma patients receiving primary cytotoxic treatment we did not find changes in anticoagulant parameters that can explain a chemotherapy-induced hypercoagulable state, as has been reported in breast cancer patients.
Collapse
Affiliation(s)
- O Bairey
- Division of Hematology, Rabin Medical Center, Tel-Aviv, Israel
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Stephens RW, Orning L, Stormorken H, Hamers MJ, Petersen LB, Sakariassen KS. Characterisation of cell-surface procoagulant activities using a microcarrier model. Thromb Res 1996; 84:453-61. [PMID: 8987166 DOI: 10.1016/s0049-3848(96)00213-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A novel model is described for characterisation of cell-surface procoagulant activities and their inhibitors. Microcarrier beads were used to present living cells to recalcified blood plasma in the stirred measuring wells of an electromagnetic coagulometer. By this means the procoagulant activity on the surface of the cells could be automatically determined as clotting time. Procoagulant activity was investigated on normal and transformed cells, and representing hemopoietic, endothelial, muscle and connective tissue phenotypes. The procoagulant activity on each cell type was characterised by the use of specifically immunodepleted plasmas and specific inhibitors, including monoclonal antibodies. The predominant cell surface trigger of coagulation found in this series was tissue factor, and only blood monocytes provided some evidence for direct activation of factor X independent of FVII. Human ECV304 transformed endothelial cells were more closely studied as representative of a cell type constitutively expressing procoagulant. Coagulation mediated by ECV304 cells was found to be strictly dependent on tissue factor, as shown by an inhibitory monoclonal antibody, and on coagulation factors V, VII and X. ECV304 procoagulant activity was strongly inhibited by active-site-inactivated FVIIa, a synthetic peptide inhibitor of FXa (Tenstop) and the thrombin inhibitor, hirudin. While not appropriate for routine clinical assessment of coagulation factor function, we have found this model to be valuable in characterising the procoagulant activity on different cell types and particularly useful as a drug discovery tool in the search for new anticoagulants.
Collapse
|
25
|
Amirkhosravi A, Biggerstaff JP, Warnes G, Francis DA, Francis JL. Determination of tumor cell procoagulant activity by Sonoclot analysis in whole blood. Thromb Res 1996; 84:323-32. [PMID: 8948059 DOI: 10.1016/s0049-3848(96)00196-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Coagulation activation in cancer may be due to expression of procoagulant activity (PCA) by tumor cells. Some PCA activate coagulation, while others influence platelet aggregation. Thus, clotting time assessments of PCA may not reflect the potential for hypercoagulability. We therefore studied the effect of various malignant and non-malignant cells on whole blood coagulation using the Sonoclot Analyzer. Five human (HT29 colon, J82 bladder, MCF-7 breast, BT-474 breast and A375 malignant melanoma) and three rodent (MC28, WEHI-164 and Neuro2a) cell lines were used. Rat thymocytes and peritoneal macrophages and human endotoxin-stimulated mononuclear cells and umbilical vein endothelial cells (HUVEC) were used as non-malignant controls. All tumor cells markedly shortened the recalcification time of citrated blood and the most potent (HT29 and J82) also increased clot rate (P < 0.01). The breast cancer cells MCF-7 and BT-474 expressed only weak PCA and did not affect clotting rate. None of the non-malignant cells significantly affected clotting time or rate in whole blood. J82 and HT29 cells grown in serum-rich media shortened the recalcification time of both normal and FVII-deficient plasmas. However, cells grown in serum-free conditions had significantly less PCA in FVII-deficient plasma. We conclude that the Sonoclot Analyzer is useful for determining cellular PCA; significant PCA is a feature of malignant cells and cells grown in medium containing serum supplements cannot be reliably evaluated for PCA.
Collapse
Affiliation(s)
- A Amirkhosravi
- Hemostasis and Thrombosis Research Unit, Walt Disney Memorial Cancer Institute, Florida Hospital, Altamonte Springs 32701, USA
| | | | | | | | | |
Collapse
|
26
|
Devie-Hubert I, Carlier M, Pozzo Di Borgo C. [Venous thrombosis on central catheters in oncology]. Rev Med Interne 1996; 17:821-5. [PMID: 8976975 DOI: 10.1016/0248-8663(96)82685-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Central venous catheters have considerably improved the comfort and safety of chemotherapy in cancer patients. However complications as thrombosis could occur and their incidence vary from 3.7 to 42% in oncology. Catheter placement induces modifications of vascular system with formation of a fibrin sleeve and/or a mural thrombus. Thrombosis origin is linked with catheter itself, its position and the biomaterial used. Hypercoagulable state in cancer results from the perturbation of blood flow, the composition of blood itself and the vessel wall, and increases the iatrogenic effects of indwelling catheters. Finally chemotherapy used in the treatment of cancer has been associated with an increased incidence of thromboembolic events, suggesting the proposal of an antithrombotic prophylaxis in cancer patients receiving chemotherapeutic agents through indwelling catheter.
Collapse
Affiliation(s)
- I Devie-Hubert
- Laboratoire d'hémostase, institut Jean-Godinot, Reims, France
| | | | | |
Collapse
|
27
|
Saxon RR, Mendel-Hartvig J, Corless CL, Rabkin J, Uchida BT, Nishimine K, Keller FS. Bile duct injury as a major cause of stenosis and occlusion in transjugular intrahepatic portosystemic shunts: comparative histopathologic analysis in humans and swine. J Vasc Interv Radiol 1996; 7:487-97. [PMID: 8855524 DOI: 10.1016/s1051-0443(96)70789-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE A comparative histologic analysis of human and swine transjugular intrahepatic portosystemic shunts (TIPS) was performed to investigate factors limiting TIPS patency and to further develop an animal model for TIPS. MATERIALS AND METHODS Twenty-one human and 13 porcine shunts were evaluated by means of gross inspection, histologic evaluation, and electron microscopy. RESULTS Severe stenosis (> 75% narrowing) or occlusion was detected with portal venography in nine of the 21 human shunts (48%) and in 10 of 13 porcine shunts (77%). Gross or histologic evidence of a substantial biliary fistula was observed in seven of nine porcine shunts and in seven of eight human shunts with severe parenchymal tract stenosis or occlusion. No evidence of substantial bile duct injury was identified in the 13 human shunts or two swine shunts with patent, nonstenotic parenchymal tracts (P < .01, Fisher exact). Histologic findings in porcine shunts mimicked human tissue responses, including a metaplastic proliferation of bile duct epithelium at sites of bile duct transection. CONCLUSION Bile duct transection and bile leak are significantly associated with TIPS parenchymal tract abnormalities in patients and swine. TIPS in swine created with the Wallstent faithfully reproduce gross morphologic and histologic changes observed in patients.
Collapse
Affiliation(s)
- R R Saxon
- Dotter Interventional Institute, Portland, OR 97201-3098, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
The association of cancer with a hypercoagulable state is documented by numerous clinical, biochemical, pathologic, and pharmacologic studies. This association is manifested clinically by an increased incidence of intravascular thrombotic events in cancer patients and by fibrin deposition in and around tumor beds. Thromboembolic disease is a major cause of morbidity and mortality in patients with malignancy. This article discusses the complex pathogenesis of this problem and the associated laboratory and clinical syndromes with recommendations on diagnosis and treatment.
Collapse
Affiliation(s)
- K B Green
- Division of Hematology-Oncology, Cornell University Medical College, New York, USA
| | | |
Collapse
|
29
|
Kazama Y, Hamamoto T, Foster DC, Kisiel W. Hepsin, a putative membrane-associated serine protease, activates human factor VII and initiates a pathway of blood coagulation on the cell surface leading to thrombin formation. J Biol Chem 1995; 270:66-72. [PMID: 7814421 DOI: 10.1074/jbc.270.1.66] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Previous studies have shown that hepsin is a putative membrane-associated serine protease that is required for cell growth (Torres-Rosado, A., O'Shea, K. S., Tsuji, A., Chou, S.-H., and Kurachi, K. (1993) Proc. Natl. Acad. Sci. U.S. A. 90, 7181 7185). In the present study, we have transfected baby hamster kidney (BHK) cells with a plasmid containing the cDNA for human hepsin and examined these cells for their ability to activate several blood coagulation factors including factors X, IX, VII, prothrombin, and protein C. Little, if any, proteolytic activation of factors X, IX, prothrombin, or protein C was observed when these clotting factors were incubated with hepsin-transfected cells. On the other hand, hepsin-transfected cells proteolytically activated significant concentrations of human factor VII in a time- and calcium-dependent manner, whereas essentially no activation of factor VII was observed in BHK cells transfected with plasmid lacking the cDNA for hepsin. The factor VII activating activity in the hepsin-transfected BHK cell line was confined exclusively to the total membrane fraction and was inhibited > 95% by antibody raised against a fusion protein consisting of maltose-binding protein and the extracellular domain of human hepsin. An active site factor VII mutant, S344A factor VII, was cleaved as readily as plasma-derived factor VII by hepsin-transfected cells, indicating that factor VII was not converted to factor VIIa autocatalytically on the cell surface. In contrast, an activation cleavage site factor VII mutant, R152E factor VII, was not cleaved by hepsin-transfected cells, suggesting that factor VII and S344A factor VII were activated on these cells by cleavage of the Arg152-Ile153 peptide bond. In the copresence of factor VII and factor X, hepsin-transfected BHK cells supported the formation of factor Xa. In addition, in the copresence of factor VII, factor X, and prothrombin, hepsin-transfected BHK cells supported the formation of thrombin. These results strongly suggest that membrane-associated hepsin converts zymogen factor VII to factor VIIa, which in turn, is capable of initiating a coagulation pathway on the cell surface that ultimately leads to thrombin formation.
Collapse
Affiliation(s)
- Y Kazama
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque 87131
| | | | | | | |
Collapse
|
30
|
Bilgrami S, Greenberg BR, Weinstein RE, Hair GA, Rickles FR. Recurrent venous thrombosis as the presenting manifestation of acute lymphocytic leukemia: leukemic cell procoagulant activity is not responsible for the hypercoagulable state. MEDICAL AND PEDIATRIC ONCOLOGY 1995; 24:40-5. [PMID: 7968791 DOI: 10.1002/mpo.2950240109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The association of cancer with clinical abnormalities of blood coagulation, including superficial thrombophlebitis, deep vein thrombosis (DVT), and disseminated intravascular coagulation (DIC) is well-known, particularly in patients with solid tumors and acute promyelocytic leukemia (APL). Less commonly appreciated is the potential for the development of venous thromboembolic disease (TED) in patients with acute lymphocytic leukemia (ALL). Multiple mechanisms have been implicated for the activation of coagulation in these patients, with an emphasis on the contribution made by the procoagulant properties of the tumor cells themselves. We present two cases of patients with pre-B cell ALL, both of whom developed recurrent TED as the presenting manifestation of their leukemia and/or heralding relapse. The blast cells from one of the patients were studied for the presence of procoagulant activity (PCA) and by Northern blot analysis for tissue factor (TF) messenger RNA (mRNA). Neither PCA nor TF mRNA could be identified in highly purified populations of the lymphoblast cells. We conclude that recurrent TED can be a manifestation of ALL and that mechanisms other than the release of tumor cell procoagulants should be sought to explain the pathogenesis of thrombosis in some patients.
Collapse
Affiliation(s)
- S Bilgrami
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CA 22202
| | | | | | | | | |
Collapse
|
31
|
Sekiya F, Usui H, Inoue K, Fukudome K, Morita T. Activation of prothrombin by a novel membrane-associated protease. An alternative pathway for thrombin generation independent of the coagulation cascade. J Biol Chem 1994. [DOI: 10.1016/s0021-9258(18)31654-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
32
|
Orvim U, Roald HE, Stephens RW, Roos N, Sakariassen KS. Tissue factor-induced coagulation triggers platelet thrombus formation as efficiently as fibrillar collagen at arterial blood flow conditions. ARTERIOSCLEROSIS AND THROMBOSIS : A JOURNAL OF VASCULAR BIOLOGY 1994; 14:1976-83. [PMID: 7981188 DOI: 10.1161/01.atv.14.12.1976] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The relative importance of vessel wall tissue factor (TF) in initiating thrombogenesis is not well defined. In contrast, vessel wall collagens have been well documented as potent inducers of thrombus formation. We compared the potency of a human TF/phospholipid surface with that of a surface consisting of human type III collagen fibrils in triggering thrombus formation in native human blood at venous and arterial blood flow conditions. A commercial preparation, Thromborel S, was used as a source of human TF. Biochemical characterization of this preparation revealed small amounts of FVII, FIX, and FX proteins. Coagulant activity of these proteins was associated with the FVII protein only, although it was a very low activity. Studies with anti-TF antibodies in a one-stage clotting assay showed that the procoagulant activity of Thromborel was mainly a result of TF. The molar ratio of TF to phospholipid was 1:2 x 10(7). Thrombus formation in flowing nonanticoagulated human blood drawn directly from an antecubital vein was triggered by either Thromborel S or collagen fibrils coated on Thermanox coverslips in a parallel-plate perfusion chamber device. A 1:50 Thromborel S dilution gave maximal fibrin deposition (90% surface coverage) at a wall shear rate of 100 s-1. However, pretreatment of the TF surface with a monoclonal anti-TF antibody reduced this fibrin deposition by 93% (P < .001). Thus, TF was essential for the procoagulant activity of the Thromborel S surface in this flow system also. At higher wall shear rates (650 and 2600s-1), less fibrin was deposited, but the platelet thrombus formation on the fibrin mesh increased dramatically.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- U Orvim
- Nycomed Bioreg AS, Oslo, Norway
| | | | | | | | | |
Collapse
|
33
|
Wright SD, Tuddenham EG. Myeloproliferative and metabolic causes. BAILLIERE'S CLINICAL HAEMATOLOGY 1994; 7:591-635. [PMID: 7841603 DOI: 10.1016/s0950-3536(05)80101-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- S D Wright
- Department of Haematology, St. Mary's Hospital, London, UK
| | | |
Collapse
|
34
|
Geczy CL. Cellular mechanisms for the activation of blood coagulation. INTERNATIONAL REVIEW OF CYTOLOGY 1994; 152:49-108. [PMID: 8206706 DOI: 10.1016/s0074-7696(08)62554-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- C L Geczy
- Heart Research Institute, Camperdown, New South Wales, Australia
| |
Collapse
|
35
|
Amirkhosravi M, Francis JL. Procoagulant activity of the MC28 fibrosarcoma cell line in vitro and in vivo. Br J Haematol 1993; 85:736-44. [PMID: 7918038 DOI: 10.1111/j.1365-2141.1993.tb03217.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Experimental evidence suggests that many tumours can activate blood coagulation and that such interaction is part of the pathology of metastatic tumour growth. This study aimed to study the procoagulant activity of the methylcholanthrene-induced (MC28) fibrosarcoma to determine whether coagulation activation by these cells could explain the previously reported effects of oral anticoagulants on lung seeding in this model. MC28 cells shortened the recalcification times of normal and factor VII-deficient plasma and directly activated factor X in a chromogenic assay, but did not aggregate platelets in vitro in either whole blood or platelet-rich plasma. Cellular coagulant activity was calcium-dependent, blocked by DFP and concanavalin A but not inhibited by iodoacetamide, E-64 or antibodies to human tissue factor or factor VII. Injection of viable MC28 cells into hooded Lister rats induced a decrease in platelet count (P < 0.001), plasma factor X (P < 0.001) and fibrinogen (P < 0.05) and a marked increase in plasma haemoglobin (P < 0.001). These effects were either not observed or were considerably less marked in heparinized or warfarinized animals. Injection of MC28 cells treated with concanavalin A in vitro completely abolished the clotting changes observed with untreated cells. In conclusion, MC28 cells possessed a potent factor X-activating serine proteinase procoagulant in vitro, which had some of the characteristics of a tissue factor/factor VIIa complex. In vivo, MC28 cells caused clotting activation and intravascular fibrin generation. Since thrombocytopenia was abolished by heparin and the cells lacked platelet aggregating activity in vitro, thrombocytopenia was probably secondary to intravascular coagulation and thrombin generation. The trigger for intravascular clotting activation appeared to be the cellular procoagulant activity since it was abolished by prior in vitro blockade of the latter with concanavalin A.
Collapse
Affiliation(s)
- M Amirkhosravi
- University Department of Haematology, General Hospital, Southampton
| | | |
Collapse
|