Elevated fibrin-related markers in patients with malignant diseases suspected of having thrombotic disorders

[Analysis of coagulation state in sudden deafness patients with total deafness and vertigo]

Objective:To analyze the coagulation status and prognosis of sudden deafness patients with total deafness accompanied by vertigo, and to provide basis for improving the treatment of this disease. Methods:From January 2017 to December 2020, 33 patients with total deafness and vertigo sudden deafness who were hospitalized in the Department of Otolaryngology Head and Neck Surgery, Hebei Provincial People's Hospital were selected as the research group. During the same period, 33 cases of low frequency type, full frequency type, total deafness and 26 cases of high frequency type were treated as control group.Thirty-three cases of inpatients without history of middle ear and inner ear diseases were treated as normal control group. The levels of fibrinogen（FIB）, D-Dimer（D-D）, Prothrombin Time（PT）, Activated Partial Thrombin Time（APTT） between the research group and the control group were analyzed, and the therapeutic effects of different types of sudden deafness patients were analyzed. Results:FIB and D-D of total deafness with vertigo were 2.50（2.11, 2.95）and 0.27（0.16, 0.51） respectively, which were higher than 2.31（1.92, 2.50） and 0.17（0.12, 0.21） of normal group. APTT was 25.2（23.1, 28.1）, lower than 27.3（26.4, 29.7） in the normal group, the differences were statistically significant（P<0.01）. ② FIB of total deafness with vertigo was 2.50（2.11, 2.95）, which was higher than that of low frequency group 2.37（1.81, 2.68）. D-D was 0.27（0.16, 0.51）, higher than low frequency group 0.16（0.12, 0.25）, high frequency group of 0.13（0.11, 0.23）, the whole frequency group 0.16（0.11, 0.28）, total of 0.18（1.45, 0.30）. APTT was 25.75±3.18/25.2（23.1, 28.1）, lower than 27.72±2.22 in low frequency group and 26.7（25.8, 28.7） in full frequency group, with statistical significance（P<0.05）. ③ The total deafness with vertigo group had the worst curative effect（ineffective rate was 63.6%）, and the low frequency group had the best curative effect（recovery rate was 75.8%）. The difference of curative effect among different types of sudden deafness groups was statistically significant（P<0.05）. Conclusion:Hypercoagulability and thrombosis may be one of the influencing factors of total sudden deafness. The hypercoagulable state of sudden deafness patients with total deafness and vertigo is more serious than that of total deafness and other types of sudden deafness, and the prognosis is the worst.

Phosphatidylserine exposing-platelets and microparticles promote procoagulant activity in colon cancer patients

Background

Colon cancer is invariably accompanied by altered coagulation activity; however, the precise role of phosphatidylserine (PS) in the hypercoagulable state of colon cancer patients remains unclear. We explored the exposure of PS on platelets and microparticles (MPs), and evaluate its role in procoagulant activity in colon cancer patients.

Methods

PS-positive platelets and MPs, mainly from platelets and endothelial cells, were detected by flow cytometry and confocal microscopy, and their procoagulant activity was assessed with purified coagulation complex assays, clotting time, and fibrin turbidity.

Results

Plasma levels of PS-positive platelets increased gradually from stage I to IV and were higher in all stages of the patients than in the healthy control, while PS-positive platelet-derived MPs only increased significantly in stage III/IV patients. Meanwhile, PS-positive MPs and endothelial-derived MPs in stage II/III/IV patients were markedly higher than ones in controls but no difference with stage I. Tissue factor positive MPs were higher in all 4 stages of colon cancer patients than in the healthy control. Platelets and MPs from the patients demonstrated significantly enhanced intrinsic/extrinsic FXa and thrombin generation, greatly shortened coagulation time, and increased fibrin formation. Combined treatment with PS antagonist lactadherin, strongly prolonged the coagulation time and reduced fibrin formation by inhibiting factor tenase and prothrombinase complex activity. In contrast, pretreatment with anti tissue factor antibody played a lesser role in suppression of procoagulant activity.

Conclusion

Our results suggest that PS-positive platelets and MPs contribute to hypercoagulability and represent a potential therapeutic target to prevent coagulation in patients with colon cancer.

Cyclophosphamide, epirubicin and fluorouracil chemotherapy-induced alteration of haemostasis markers in breast cancer patients

The occurrence of chemotherapy-induced alterations in markers of haemostasis during chemotherapy has been reported previously. However, the change of the haemostasis markers in the cyclophosphamide, epirubicin and fluorouracil (CEF) regimen remains unclear. The aim of the present study was to identify the change of the haemostasis markers during systemic chemotherapy (600 mg/m² cyclophosphamide, 80 mg/m² epirubicin and 500 mg/m² fluorouracil; four courses over 21 days) to investigate its influence on the haemostasis markers of breast cancer patients and to discuss the requirement of anticoagulation therapy. D-dimer, activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen (FIB) values were obtained before chemotherapy and on days 1, 4, 7 and 21. The results show that PT, D-dimer and FIB were not prolonged prior to chemotherapy compared to that under the control. APTT was prolonged until day 4. The levels of D-dimer and APTT were significantly higher compared to those of the breast cancer patients before receiving chemotherapy and controls on days 1, 4, 7 and 21 after chemotherapy. Alteration of the haemostasis markers occurred in the breast cancer patients under the CEF chemotherapy regimen. As there is an increased risk of deep vein thrombosis and pool prognosis of cancer patients, anticoagulant therapy should be considered.

Elevated fibrin-related markers in patients with malignant diseases frequently associated with disseminated intravascular coagulation and venous thromboembolism

OBJECTIVE

Many patients with malignant diseases are frequently complicated with some type of thrombosis, such as venous thromboembolism (VTE) or disseminated intravascular coagulation (DIC).

METHODS

This retrospective study was designed to examine the frequency of thrombosis in 478 patients with malignant diseases in comparison to that observed in 121 patients without malignant diseases and to evaluate the efficacy of fibrin-related markers (FRMs), such as soluble fibrin, fibrinogen and fibrin degradation products and D-dimer, in diagnosing thrombosis.

RESULTS

The frequency of thrombosis, including 62 cases of VTE, 63 cases of DIC and nine cases of cerebrovascular thrombosis, was significantly higher in the patients with malignant diseases (28.0%) than in the patients without malignant diseases (12.5%). DIC was frequently detected in the patients with hepatic cell cancer and hematopoietic malignancy, while VTE was frequently observed in the patients with colon cancer, breast cancer and urinary tract cancer. The FRMs levels were significantly higher in the patients with thrombosis than in the patients without thrombosis. A receiver operating characteristic analysis showed these markers to be useful for diagnosing thrombosis.

CONCLUSION

Patients with malignant diseases have a high risk of thrombosis, and elevated FRMs levels are useful for diagnosing thrombosis in patients with malignant diseases.