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A pilot study on the applicability of thromboelastometry in detecting brain tumour-induced hypercoagulation

Jansohn, Erik; Bengzon, Johan LU ; Kander, Thomas LU and Schött, Ulf LU (2017) In Scandinavian Journal of Clinical and Laboratory Investigation 77(4). p.289-294
Abstract

Patients with intracranial tumours have an increased risk of venous thromboembolism, particularly during the first month after neurosurgery. A proposed explanation for this increased risk, are procoagulant tumour-derived substances, such as tissue factor, usually measured in peripheral blood. The aim of the present study is to investigate whether a rotational thromboelastometry (ROTEM) can measure the procoagulative activity of tumour tissue. The study included 21 patients who were undergoing a craniotomy and complete tumour resection after written consent and ethical approval were obtained. Tumour tissue was biopsied during surgery and used for in vitro spiking of patients own citrated whole blood. Blood samples with or without spiking... (More)

Patients with intracranial tumours have an increased risk of venous thromboembolism, particularly during the first month after neurosurgery. A proposed explanation for this increased risk, are procoagulant tumour-derived substances, such as tissue factor, usually measured in peripheral blood. The aim of the present study is to investigate whether a rotational thromboelastometry (ROTEM) can measure the procoagulative activity of tumour tissue. The study included 21 patients who were undergoing a craniotomy and complete tumour resection after written consent and ethical approval were obtained. Tumour tissue was biopsied during surgery and used for in vitro spiking of patients own citrated whole blood. Blood samples with or without spiking were analyzed with ROTEM using different activating reagents. ROTEM clotting time significantly decreased (p < .001), indicating a hypercoagulative response on clot initiation that was strongest for glioma tumours. However, ROTEM clot formation time was significantly prolonged (p < .001), which was an opposite response that indicated poor initial clot propagation. ROTEM maximum lysis was increased in the tumour tissue-spiked samples (p < .001), indicating a strong fibrinolytic activity in brain tumour tissue. Tissue extracts from intracranial tumours have both procoagulant and fibrinolytic effects that are detectable with ROTEM. Glioma tumours had the strongest hypercoagulative response in our in vitro model. Larger studies are necessary to test the clinical relevance and accuracy of tumour extract spiked viscoelastic tests to predict the individual patient risk for developing a thrombotic complication.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Glioma, neurosurgery, point-of-care testing, proteins and enzymes, surgery, thrombelastography, tumor markers
in
Scandinavian Journal of Clinical and Laboratory Investigation
volume
77
issue
4
pages
6 pages
publisher
Informa Healthcare
external identifiers
  • scopus:85016478646
  • wos:000401554800010
ISSN
0036-5513
DOI
10.1080/00365513.2017.1306877
language
English
LU publication?
yes
id
e7be1ff7-487f-41cc-9534-141911db25af
date added to LUP
2017-04-12 12:05:32
date last changed
2017-11-12 04:31:06
@article{e7be1ff7-487f-41cc-9534-141911db25af,
  abstract     = {<p>Patients with intracranial tumours have an increased risk of venous thromboembolism, particularly during the first month after neurosurgery. A proposed explanation for this increased risk, are procoagulant tumour-derived substances, such as tissue factor, usually measured in peripheral blood. The aim of the present study is to investigate whether a rotational thromboelastometry (ROTEM) can measure the procoagulative activity of tumour tissue. The study included 21 patients who were undergoing a craniotomy and complete tumour resection after written consent and ethical approval were obtained. Tumour tissue was biopsied during surgery and used for in vitro spiking of patients own citrated whole blood. Blood samples with or without spiking were analyzed with ROTEM using different activating reagents. ROTEM clotting time significantly decreased (p &lt; .001), indicating a hypercoagulative response on clot initiation that was strongest for glioma tumours. However, ROTEM clot formation time was significantly prolonged (p &lt; .001), which was an opposite response that indicated poor initial clot propagation. ROTEM maximum lysis was increased in the tumour tissue-spiked samples (p &lt; .001), indicating a strong fibrinolytic activity in brain tumour tissue. Tissue extracts from intracranial tumours have both procoagulant and fibrinolytic effects that are detectable with ROTEM. Glioma tumours had the strongest hypercoagulative response in our in vitro model. Larger studies are necessary to test the clinical relevance and accuracy of tumour extract spiked viscoelastic tests to predict the individual patient risk for developing a thrombotic complication.</p>},
  author       = {Jansohn, Erik and Bengzon, Johan and Kander, Thomas and Schött, Ulf},
  issn         = {0036-5513},
  keyword      = {Glioma,neurosurgery,point-of-care testing,proteins and enzymes,surgery,thrombelastography,tumor markers},
  language     = {eng},
  month        = {03},
  number       = {4},
  pages        = {289--294},
  publisher    = {Informa Healthcare},
  series       = {Scandinavian Journal of Clinical and Laboratory Investigation},
  title        = {A pilot study on the applicability of thromboelastometry in detecting brain tumour-induced hypercoagulation},
  url          = {http://dx.doi.org/10.1080/00365513.2017.1306877},
  volume       = {77},
  year         = {2017},
}