Value of maximum amplitude of thrombus in thromboelastogram in predicting occurrence of venous thrombosis in patients after lung cancer surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Yafei , ZONG Liang , ZHANG Haiping , ILYAR Sheyhidin ,  ZHU Hui

Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830001, P. R. China;

Corresponding author：

ZHU Hui, Email: Zhuhui1973@163.com

Keywords：

Lung cancer; thromboelastogram; maximum amplitude of thrombus; venous thromboembolism

DOI：

10.7507/1007-4848.202012010

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Objective To explore the predictive value of the maximum amplitude (MA) in the thromboelastogram (TEG) in the occurrence of venous thromboembolism (VTE) in patients with lung cancer after surgery.Methods Forty-one lung cancer patients with postoperative VTE in our hospital from September 2018 to August 2020 were enrolled into a thrombosis group, including 25 males and 16 females, aged 72.17±10.08 years. The 87 lung cancer patients who underwent surgery during the same period but did not suffer postoperative VTE were enrolled into a control group, including 51 males and 36 females, aged 71.06±9.49 years. The MA of thrombus in the TEG before and after the operation was compared between the two groups, and logistic regression analysis was used to test the value of the MA of thrombus at each time point in the TEG to predict the occurrence of VTE in patients with lung cancer surgery. The receiver operating characteristic curve was drawn to test the effectiveness of the MA of thrombus at each time point in the TEG to predict the occurrence of VTE in patients with lung cancer.Results The MA of thrombus in the two groups after operation was greater than that before operation, and the MA of thrombus in the TEG on the day 3 after operation in the two groups> day 1> day 5 (P<0.05). The logistic regression analysis showed that the MA of thrombus in the TEG increased, which had predictive value for the occurrence of VTE in patients with lung cancer after surgery; the MA of thrombus in the TEG at each postoperative point was used as the test variable. Taking the occurrence of VTE as a state variable, the area under the curve (AUC) of MA of thrombus in the TEG on the 1st postoperative day was 0.82, and its optimal threshold was 75.15 mm; on the 3rd postoperative day, AUC was 0.88, and its optimal threshold was 80.05 mm; on the 5th day afterwards, AUC was 0.78, and its optimal threshold was 66.30 mm.Conclusion The MA of TEG has a high predictive power for the occurrence of VTE in lung cancer patients after surgery, which suggests that TEG dynamic monitoring should be performed before surgery for lung cancer patients, and a reasonable anticoagulation plan should be formulated accordingly to reduce the occurrence of VTE.

Citation： YU Yafei, ZONG Liang, ZHANG Haiping, ILYAR Sheyhidin, ZHU Hui. Value of maximum amplitude of thrombus in thromboelastogram in predicting occurrence of venous thrombosis in patients after lung cancer surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(7): 899-903. doi: 10.7507/1007-4848.202012010 Copy

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2.	姜瑞恒, 李彤, 李辉. 《胸部恶性肿瘤围术期静脉血栓栓塞症预防中国专家共识(2018版)》解读之直接口服抗凝药应用前瞻篇. 中国肺癌杂志, 2019, 22(12): 757-760.
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11.	Piche SL, Nei SD, Frazee E, et al. Baseline thromboelastogram as a predictor of left ventricular assist device thrombosis. ASAIO J, 2019, 65(5): 443-448.
12.	郭瑛, 郝玉芝, 张育荣. 肿瘤患者血栓弹力图检测的状况分析及对血栓的诊断效能评价. 国际检验医学杂志, 2020, 41(16): 1999-2002.
13.	Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res, 2018, 30(1): 1-12.
14.	Varon D, Shai E. Role of platelet-derived microparticles in angiogenesis and tumor progression. Discov Med, 2009, 8(43): 237-241.
15.	Bai J, Zheng QW, Fu SH, et al. Association between thrombelastography system and thromboembolic and bleeding events in Chinese aged people. Int J Clin Exp Med, 2013, 6(4): 310-319.
16.	McCrath DJ, Cerboni E, Frumento RJ, et al. Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction. Anesth Analg, 2005, 100(6): 1576-1583.
17.	Zeng C, Wang X, Hu X, et al. Autologous endothelial progenitor cells transplantation for the therapy of primary pulmonary hypertension. Med Hypotheses, 2007, 68(6): 1292-1295.
18.	Xu C, Fu X. The changes of blood coagulation in surgical patients with lung cancer. Zhongguo Fei Ai Za Zhi, 2010, 13(2): 136-139.
19.	Kuderer NM, Ortel TL, Francis CW. Impact of venous thromboembolism and anticoagulation on cancer and cancer survival. J Clin Oncol, 2009, 27(29): 4902-4911.
20.	Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med, 2002, 346(13): 975-980.

1. Khorana AA. The NCCN clinical practice guidelines on venous thromboembolic disease: Strategies for improving VTE prophylaxis in hospitalized cancer patients. Oncologist, 2007, 12(11): 1361-1370.
2. 姜瑞恒, 李彤, 李辉. 《胸部恶性肿瘤围术期静脉血栓栓塞症预防中国专家共识(2018版)》解读之直接口服抗凝药应用前瞻篇. 中国肺癌杂志, 2019, 22(12): 757-760.
3. Peng G, Zhang J, Jia B, et al. Submaximal primary angioplasty for symptomatic intracranial atherosclerosis: Peri-procedural complications and long-term outcomes. Neuroradiology, 2019, 61(1): 97-102.
4. Imberti D, Agnelli G, Ageno W, et al. Clinical characteristics and management of cancer-associated acute venous thromboembolism: Findings from the MASTER Registry. Haematologica, 2008, 93(2): 273-278.
5. 孙益鑫, 李辉. 《胸部恶性肿瘤围术期静脉血栓栓塞症预防中国专家共识(2018版)》解读之流行病学篇. 中国肺癌杂志, 2019, 22(12): 741-746.
6. Khorana AA, Carrier M, Garcia DA, et al. Guidance for the prevention and treatment of cancer-associated venous thromboembolism. J Thromb Thrombolysis, 2016, 41(1): 81-91.
7. Gonzalez E, Moore EE, Moore HB. Management of trauma-induced coagulopathy with thrombelastography. Crit Care Clin, 2017, 33(1): 119-134.
8. 于鹏跃, 赵凤莲, 张晓华, 等. 血栓弹力图、平均血小板体积/血小板计数比值和纤维蛋白原水平对复发性流产的预测价值. 吉林大学学报(医学版), 2020, 46(1): 127-131.
9. 蔡娟, 郑勇. 凝血功能异常患者血栓弹力图与常规凝血指标检测的比较分析. 医学检验与临床, 2020, 31(8): 19-22.
10. Volod O, Lam LD, Lin G, et al. Role of thromboelastography platelet mapping and international normalized ratio in defining "normocoagulability" during anticoagulation for mechanical circulatory support devices: A pilot retrospective study. ASAIO J, 2017, 63(1): 24-31.
11. Piche SL, Nei SD, Frazee E, et al. Baseline thromboelastogram as a predictor of left ventricular assist device thrombosis. ASAIO J, 2019, 65(5): 443-448.
12. 郭瑛, 郝玉芝, 张育荣. 肿瘤患者血栓弹力图检测的状况分析及对血栓的诊断效能评价. 国际检验医学杂志, 2020, 41(16): 1999-2002.
13. Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res, 2018, 30(1): 1-12.
14. Varon D, Shai E. Role of platelet-derived microparticles in angiogenesis and tumor progression. Discov Med, 2009, 8(43): 237-241.
15. Bai J, Zheng QW, Fu SH, et al. Association between thrombelastography system and thromboembolic and bleeding events in Chinese aged people. Int J Clin Exp Med, 2013, 6(4): 310-319.
16. McCrath DJ, Cerboni E, Frumento RJ, et al. Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction. Anesth Analg, 2005, 100(6): 1576-1583.
17. Zeng C, Wang X, Hu X, et al. Autologous endothelial progenitor cells transplantation for the therapy of primary pulmonary hypertension. Med Hypotheses, 2007, 68(6): 1292-1295.
18. Xu C, Fu X. The changes of blood coagulation in surgical patients with lung cancer. Zhongguo Fei Ai Za Zhi, 2010, 13(2): 136-139.
19. Kuderer NM, Ortel TL, Francis CW. Impact of venous thromboembolism and anticoagulation on cancer and cancer survival. J Clin Oncol, 2009, 27(29): 4902-4911.
20. Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med, 2002, 346(13): 975-980.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Value of maximum amplitude of thrombus in thromboelastogram in predicting occurrence of venous thrombosis in patients after lung cancer surgery

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