COAGULATION CHANGES ONE YEAR AFTER RESECTION OF INTRAABDOMINAL MALIGNANCY Robert M. Van Haren MD, Evan J. Valle MD, Chad M.
Thorson MD MSPH, Gerardo A. Guarch MD, Jassin M. Jouria MD, Alexander M. Busko BS,
Danny Sleeman MD, Joe U. Levi MD, Alan S. Livingstone MD, Kenneth G. Proctor PhD
Daughtry Dept of Surgery, University of Miami Miller School of Medicine
Background: A significant fraction of the morbidity and mortality in cancer patients can be
attributed to malignant hypercoagulability. Surgical resection of malignancy should theoretically
reverse hypercoagulability. However, we previously demonstrated that patients develop
worsening hypercoagulability after resection, and that this condition persists at least one month
post-operatively.
Objectives: To test hypothesis that cancer induced hypercoagulability is eventually reversed
during long-term follow-up from successful resection.
Methods: A prospective trial was conducted with informed consent at an academic medical
center. Blood samples were obtained from cancer patients undergoing surgical resection for
curative intent pre-operatively (pre-op) and post-operatively (post-op) for up to one year.
Rotational thromboelastography (ROTEM) provides a global measurement of coagulation and
was performed on whole blood samples. Data are presented as mean±SD. Repeated measures
ANOVA were used; significance was assessed at p<0.05.
Results: 47 patients, age 66±11 yrs and 60% male were enrolled. Cancers primarily involved
the esophagus (n=15, 32%), pancreas (n=15, 32%), stomach (n=6, 13%), and liver (n=4, 9%). 13
patients (28%) were hypercoagulable on pre-op ROTEM. Post-op, patients were more
hypercoagulable with shorter clot formation time (low CFT) and higher maximum clot firmness
(MCF) (all p<0.05). Long term data on average revealed a return to baseline coagulation status
(see table), however 21 patients (45%) had a reversal of cancer induced hypercoagulability. .
Two patients developed venous thromboembolism (VTE) and were hypercoagulable (alpha:
76.1±3.0 vs. 81.0±4.2, p=0.029).
Conclusion: Almost a third of patients with intra-abdominal malignancy are hypercoagulable
pre-op. Surgical resection initially increases hypercoagulable state, and then returns to baseline
during long term follow-up. Surgical resection reverses cancer induced hypercoagulability in
some, but not all patients. This findings support the use of VTE prophylaxis for 1 month postoperatively.
Coagulation Changes After Surgical Resection of Intra-abdominal Malignancies, n=47
Pre-Op
Post-Op Day 1
6-12 months
p=
Intrinsic Pathway
CT, sec
163.5±27.3
167.1±24.3
177.5±47.0
0.118
CFT, sec
74.9±25.0
68.2±19.5
80.4±40.1
0.103
MCF, mm
61.5±5.7*
64.4±6.7*
62.5±8.9
0.046
Alpha, degrees
76.3±3.1
76.7±3.3
75.0±5.6
0.099
Extrinsic Pathway
CT, sec
54.7±15.9
59.3±14.3*
50.6±16.2*
0.004
CFT, sec
82.7±25.3*
74.5±21.6*
79.8±34.9
0.282
MCF, mm
64.7±6.3*
67.7±5.7*
65.0±9.1
0.068
Alpha, degrees
76.0±3.9
76.2±4.3
76.3±5.6
0.461
Final Common Pathway (Fibrin)
MCF, mm
20.2±8.1*
25.6±7.8*
22.6±11.0
0.014