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“Holistic” coagulation test could lower mortality rate with cancer

(Vienna, 3 May 2011) A team of researchers at MedUni Vienna headed by Ingrid Pabinger-Fasching have examined a new procedure for measuring blood coagulation for the first time in cancers. The aim is to be able to better assess the risk of thrombosis in cancer patients and therefore reduce the risk of the patients dying from this serious complication.

Cancer considerably increases the risk of a clot in the veins. Deep leg vein thromboses and pulmonary embolisms represent a serious complication of the disease and often lead to death.

New test procedure gives clear results
In the current study a new test procedure was examined in which a one-off measurement is used to determine how much thrombin the patients’ bodies can produce (endogenous thrombin potential). Thrombin is the most important enzyme for blood coagulation and therefore a key factor in blood coagulation. The researchers showed that patients with cancer and high thrombin potential have more than twice the risk of developing a deep vein leg thrombosis or pulmonary embolism.

Unlike conventional coagulation tests where only individual coagulation factors are examined, the entire blood clotting process is included in this new procedure. This means it can be estimated very precisely how much thrombin is produced and therefore how big the risk of a thrombosis is.

With the new test procedure blood-thinning treatment measures could also be used early enough if there is an increased risk. The individual components of the procedure still need to be harmonised, however, to enable use in clinical practice.

A further success of the MedUni Vienna study “CATS”
The new test procedure is not the first success of the “Vienna Cancer and Thrombosis Study (CATS)”, which is carried out under the supervision of Pabinger-Fasching at Department of Medicine I of MedUni Vienna.  The study aims to identify cancer patients with a low or high risk of thrombosis and develop strategies for targeted blood-thinning treatment to prevent thromboses.

The study results so far have already revealed many findings about new risk factors for the occurrence of thrombosis in cancer patients. It was shown that different biomarkers are connected with the risk of cancer-associated thrombosis. At the same time valuable information was thus gained on mechanisms which lead to the development of thrombosis in cancer patients in particular.

Only recently the working group headed by Ingrid Pabinger-Fasching and Cihan Ay was also able to create its own risk model for predicting the probability of thrombosis in which laboratory parameters and biomarkers are taken into consideration as well as clinical parameters. These include tumour entity, body mass index, number of thrombocytes and leucocytes, haemoglobin level and also soluble P-selectin and D-dimer. These findings could also soon be integrated into therapeutic and prophylactic decision-making.

Together with the now examined test procedure for the generation potential of thrombin, the researchers have already found two good approaches for lowering the increased risk of thrombosis in cancer patients and preventing this serious complication.

Participating scientists:
Univ. Ingrid Pabinger-Fasching
, head of the study, Department of Medicine I at MedUni Vienna.
Priv. Doz. Dr. Cihan Ay, lead author, Department of Medicine I at MedUni Vienna.

Publication in „Journal of Clinical Oncology“:
» Prediction of Venous Thromboembolism in Patients With Cancer By Measuring Thrombin Generation: Results From the Vienna Cancer and Thrombosis Study
Cihan Ay, Daniela Dunkler, Ralph Simanek, Johannes Thaler, Silvia Koder, Christine Marosi, Christoph Zielinski and Ingrid Pabinger
doi: 10.1200/JCO.2010.32.8294