Physiologic Inhibitors of Coagulation, Thrombophilic Acquired Factors and Venous Thromboembolism in Gastrointestinal Cancer Patients.

Venous Thromboembolism (VTE) in cancer patients recognizes a multifactorial pathogenesis, depending on endogeous and esogenous factors. However, the relationship among VTE and laboratoristic thrombophilic alterations in cancer patients is not clearly known. Aim of our trial has been to evaluate changes in the levels of physiological coagulation inhibitors and some thrombophilic acquired factors in a cohort of gastrointestinal tumours patients considering four timepoints of their medical history. All patients over 18 years with a new diagnosis of malignant gastrointestinal neoplasm observed in the Surgery department of the University Hospital “Campus Bio-Medico” from October 2002 to June 2004 have been included in this trial. Patients with antineoplastic previous treatment, anticoagulant current therapies, autoimmune or hematological diseases were not included. The following physiological coagulation inhibitors have been tested: Protein C, Protein S, Antithrombin III. Moreover, we tested also the presence of Lupus Anticoagulant by mean of Silica Clotting Time (SCT), Diluted Russel Viper Venom Test (DRVVT) and Anticardiolipin Antibodies of IgG type (ACA IgG). Furthermore, we investigated also the levels of homocysteine and annexin V as well as the presence of activated Protein C resistance. Tests were performed on samples taken just before and after surgery as well as before and at the end of the chemotherapeutic protocols. In addiction, VTE’s prevalence has been evaluated. A total of 102 patients (60 males and 42 females) have been included; median age was 67 years (range 28–92). A significant modification in the values of DRVVT, ACA IgG, PS, ATIII has been observed in the samples taken just after surgery (P <.001) and just before chemotherapy (P <.004). Moreover, PC levels were significantly reduced only after surgery (P <.000); SCT was significantly prolonged before starting chemotherapy (P <.003) while homocysteine levels were significantly reduced (P <.001) just after the end of the chemotherapeutic protocols. In this cohort of patients, VTE’s prevalence has been 7,8% (8/102) of these, 5/8 (62,5%) were treated with FU-based therapies and 3/8 (37,5%) had a Central Venous Catheter. None of the thrombophilic parameters tested was correlated with the development of VTE, while an advanced disease (P<.024) was strongly correlated to VTE. These preliminar results agree with other published trials as for the reduction in physiological coagulation inhibitors after surgery and VTE’s prevalence in cancer patients. Moreover, as expected, patients with advanced inoperable disease experience more easily VTE. Surprisingly, FU-based therapies reduce the levels of homocysteine in this cohort of patients. Increasing the number of studied patients may better clarify which are, in addiction to advanced disease, the more useful parameters for identifying those patients with gastrointestinal cancers at risk of VTE who may, therefore, benefit of a correct VTE prophylaxis.