OC 46.5 - Tissue Factor Pathway Inhibitor is associated with risk of venous thromboembolism and all-cause mortality in patients with cancer

Monday, June 26, 2023

15:45 – 16:00 ET

Room: 510

Session Available As: On-Demand

Presenting Author(s)

Cornelia Englisch, MD

PhD Student
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria
Vienna, Wien, Austria

Co-Author(s)

Florian Moik, MD PhD (he/him/his)

Medical University of Vienna, Department of Medicine I, Clinical Division of Haematology and Haemostaseology
Vienna, Austria
Johannes Thaler, MD, PhD (he/him/his)

Specialist Hematology
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Austria
Vianna, Wien, Austria
SK

Silvia Koder

Technician
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Austria
Vienna, Vorarlberg, Austria
MP

Matthias Preusser

Head of Division
Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Austria
Vienna, Wien, Austria
Ingrid Pabinger, MD

Co-Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
Cihan Ay, MD (he/him/his)

Professor, Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria

Background: Venous thromboembolism (VTE) is a common complication in patients with cancer. Tissue factor pathway inhibitor (TFPI) is a natural anticoagulant inhibiting complexes of tissue factor (TF) and factor VIIa/factor Xa. Conflicting results about its association with VTE risk in the general population and higher TFPI levels in cancer patients were reported.

Aims: We aimed to investigate TFPI levels and their association with VTE risk and all-cause mortality in cancer patients.

Methods: Total TFPI antigen levels at study inclusion (Imunbind total TFPI ELISA kit, American Diagnostica Inc.) were measured in patients included in the Vienna Cancer and Thrombosis Study, a prospective observational cohort study with the primary outcome VTE.

Results: TFPI was analyzed in 898 patients (median age 62 years, interquartile range [IQR]:53-68; 407 (45%) female). Sixty-seven patients were diagnosed with VTE and 387 patients died (24-month cumulative risk: 7.5%, 42.1%). Patients had median TFPI levels of 56.4ng/mL (IQR:45-70) and those with metastatic disease had higher levels (60 vs. 50.4ng/mL, p< 0.001). Distribution of TFPI levels did not significantly differ between cancer types.
In multivariable analysis adjusting for age, sex, cancer type and stage, baseline levels of TFPI were associated with risk of VTE (SHR per doubling: 2.01, 95% confidence interval [CI]: 1.25-3.24; 1-year cumulative incidence >75th vs ≤75th percentile: 9.7 vs 5.8, p=0.04, figure 1). When TF levels were added to the multivariable analysis, the association was significantly weakened (adjusted SHR per doubling: 1.54, 95%CI: 0.93-2.54). TFPI was independently associated with risk of all-cause mortality (adjusted HR per doubling: 1.86, 95%CI: 1.47-2.35; 1-year cumulative incidence >75th vs ≤75th percentile: 47.2 vs 21.7, p< 0.001, figure 2).

Conclusion(s): TFPI levels are associated with risk of VTE and all-cause mortality in cancer patients. TFPI levels might represent a surrogate and could be a biomarker for the prediction of VTE risk and mortality in patients with cancer.

Learning Objectives:

Upon completion, participants will be able to describe the role of tissue factor pathway inhibitor (TFPI) in the coagulation cascade.
Upon completion, participants will be able to discuss the association between TFPI and VTE risk and all-cause mortality in patients with cancer.
Upon completion, participants will be able to recognize the impact of the contact pathway on cancer-associated thrombosis.