Contributions
Abstract: O01
Type: Oral presentation
Session Topic: Inherited and acquired coagulation disorders
Presentation during EHA Scientific Conference on Bleeding Disorders:
On Thursday, September 15, 2016 from 09:00 - 10:30
Location: Rubí + Zafir
Background
Peritoneal carcinomatosis, a condition characterized by widespread tumor metastases in the peritoneal cavity, occurs frequently in gastrointestinal (GI) and ovaric (OV) carcinomas. Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment protocol; however, it is frequently associated with a hemostatic derangement and a significant blood loss requiring intensive blood transfusion.
Aim
Our aim was to prospectically characterize the hemostatic global profiles of patients with peritoneal carcinomatosis before and during CRS and HIPEC procedures, as measured by ROTEMTM, prothrombin time (PT), activated partial thromboplastin time (aPTT) and fibrinogen. The relation of these parameters with blood loss was also evaluated.
Material and methods
Twenty-six cancer patients (15 GI, 11 OV) with a median age of 55 years (range: 35-72 years) were recruited at our Institution, after informed consent. Venous blood samples were collected before surgery (=T0), after CRS (=T1) and after HIPEC (=T2). Thromboelastometry was performed using EXTEM and FIBTEM reagents, to evaluate extrinsic coagulation pathway and fibrinogen concentration. Clotting time (CT, time to clotting initiation), clot formation time (CFT, time of clot increase from 2mm to 20mm above baseline) and maximum clot firmness (MCF, maximum tensile strength of the thrombus) were evaluated.
Results
Before surgery, patients showed significantly (p<0.005) higher PT ratio and higher fibrinogen levels than healthy subjects. According to ROTEM analysis, all patients displayed parameters within the normal range values, however the patient group showed a prolonged (p<0.005) CT in both EXTEM and FIBTEM tests compared to controls. In addition, MCF was significantly higher in patients compared to healthy controls (p<0.001) in FIBTEM test only. After CRS, at T1, fibrinogen levels significantly (p<0.005) dropped, and the PT ratio further increased, while no changes were observed for aPTT. Finally ROTEM data showed a significant (p<0.001) prolongation of CFT and decrease of MCF values. At T2, after HIPEC, the PT ratio further increased, while fibrinogen level remained unchanged compared to T1. At the same time point a significant reduction of the MCF occurred in both EXTEM and FIBTEM tests. During the procedure 1 patient had severe and 4 had minor bleeding complications.
Conclusions
Treatment of peritoneal carcinomatosis with CRS and HIPEC is associated to a reduction in fibrinogen levels and a pro-hemorrhagic profile. These alterations appear after CRS and worsen after HIPEC. Due to the small number of patients we could not find a correlation with bleeding events or transfusion needs, however our data show that ROTEM may be a promising test to evaluate the perioperative bleeding risk in these patients.
Abstract: O01
Type: Oral presentation
Session Topic: Inherited and acquired coagulation disorders
Presentation during EHA Scientific Conference on Bleeding Disorders:
On Thursday, September 15, 2016 from 09:00 - 10:30
Location: Rubí + Zafir
Background
Peritoneal carcinomatosis, a condition characterized by widespread tumor metastases in the peritoneal cavity, occurs frequently in gastrointestinal (GI) and ovaric (OV) carcinomas. Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment protocol; however, it is frequently associated with a hemostatic derangement and a significant blood loss requiring intensive blood transfusion.
Aim
Our aim was to prospectically characterize the hemostatic global profiles of patients with peritoneal carcinomatosis before and during CRS and HIPEC procedures, as measured by ROTEMTM, prothrombin time (PT), activated partial thromboplastin time (aPTT) and fibrinogen. The relation of these parameters with blood loss was also evaluated.
Material and methods
Twenty-six cancer patients (15 GI, 11 OV) with a median age of 55 years (range: 35-72 years) were recruited at our Institution, after informed consent. Venous blood samples were collected before surgery (=T0), after CRS (=T1) and after HIPEC (=T2). Thromboelastometry was performed using EXTEM and FIBTEM reagents, to evaluate extrinsic coagulation pathway and fibrinogen concentration. Clotting time (CT, time to clotting initiation), clot formation time (CFT, time of clot increase from 2mm to 20mm above baseline) and maximum clot firmness (MCF, maximum tensile strength of the thrombus) were evaluated.
Results
Before surgery, patients showed significantly (p<0.005) higher PT ratio and higher fibrinogen levels than healthy subjects. According to ROTEM analysis, all patients displayed parameters within the normal range values, however the patient group showed a prolonged (p<0.005) CT in both EXTEM and FIBTEM tests compared to controls. In addition, MCF was significantly higher in patients compared to healthy controls (p<0.001) in FIBTEM test only. After CRS, at T1, fibrinogen levels significantly (p<0.005) dropped, and the PT ratio further increased, while no changes were observed for aPTT. Finally ROTEM data showed a significant (p<0.001) prolongation of CFT and decrease of MCF values. At T2, after HIPEC, the PT ratio further increased, while fibrinogen level remained unchanged compared to T1. At the same time point a significant reduction of the MCF occurred in both EXTEM and FIBTEM tests. During the procedure 1 patient had severe and 4 had minor bleeding complications.
Conclusions
Treatment of peritoneal carcinomatosis with CRS and HIPEC is associated to a reduction in fibrinogen levels and a pro-hemorrhagic profile. These alterations appear after CRS and worsen after HIPEC. Due to the small number of patients we could not find a correlation with bleeding events or transfusion needs, however our data show that ROTEM may be a promising test to evaluate the perioperative bleeding risk in these patients.