PB0937 - Association of fibrinolytic potential and risk of mortality in cancer patients

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Silmara L. Montalvao, PhD (she/her/hers)

Responsible for the Haemostasis Laboratory
Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
Campinas, Sao Paulo, Brazil

Co-Author(s)

GG

Gabriele Silva Souza Gois

Master student
FCM-UNICAMP, University of Campinas, Campinas-SP, Brazil
Paulínia, Sao Paulo, Brazil
MH

Millene Honorato

Master student
Laboratory of Hemostasis, HEMOCENTRO-UNICAMP, University of Campinas, Campinas, São Paulo, Brazil.
Campinas, Sao Paulo, Brazil
TR

Thaizy Rodrigues

Master Student
FCM-UNICAMP
Campinas, Sao Paulo, Brazil
BM

Beatriz Martinelli

Biologist
Hemocentro-UNICAMP, University of Campinas, Campinas-SP, Brazil
Campinas, Sao Paulo, Brazil
JC

José Carvalheira

Professor
FCM-UNICAMP, University of Campinas, Campinas-SP, Brazil
Campinas, Sao Paulo, Brazil
NA

Nelson Andreollo

Professor
FCM-UNICAMP, University of Campinas, Campinas-SP, Brazil
Campinas, Sao Paulo, Brazil
JT

Júlio Teixeira

Professor
FCM-UNICAMP, University of Campinas, Campinas-SP, Brazil
Campinas, Sao Paulo, Brazil
JA

Joyce Annichino-Bizzacchi

Professor of Hematology
Laboratory of Hemostasis, HEMOCENTRO-UNICAMP, University of Campinas, Campinas, São Paulo, Brazil.
Campinas, Sao Paulo, Brazil

Background: Cancer is among the top four causes of death before the age of 70 and, associated with its many issues, significantly impacts the public health at multiple levels. Cancer patients are at risk for thromboembolic events, complications, tumor progression and death. The fibrinolytic system, which is involved in hemostasis, shows cooperative effects that facilitate the growth of tumors and the appearance of metastases. Prospective data regarding the fibrinolytic system and describing clinical outcomes for cancer patients are limited.

Aims: This prospective study aims at evaluating the fibrinolytic potential in cancer patients and its association with mortality outcomes through the use of the fluorometric method of simultaneous thrombin and plasmin generation.

Methods: The study included 323 patients with progression or recent cancer diagnosis followed for 12 months, and 148 healthy individuals. During the follow-ups, 68 patients died and 10 were lost.

Results: Compared to the control group, cancer patients showed alterations in thrombin generation parameters consistent with a hypercoagulability profile, as well as an increase in plasmin production evidenced by the parameters extracted from the curves (Figure 01). Parameters referring to maximum amplitude (MA) of thrombin (Wald 11.78, HR 1.02, P< 0.001), area under the curve (AUC) of thrombin (Wald 8.0, HR 1.02, P< 0.005) and time for maximum velocity (tMV) of plasmin (Wald 4.92, HR 1.0, P< 0.027) showed association with mortality risk in univariate cox analysis (Table 1). This association was statistically significant for MA and AUC of Thrombin after adjusting for demographic and clinical data, while for plasmin such associations were not maintained.

Conclusion(s): This was the first study able to demonstrate the simultaneous evaluation of thrombin and plasmin generation in newly diagnosed untreated cancer patients. The concentration of thrombin formed, and the size of the fibrin clot appear to be important tools to stratify the patient to the risk of death.