Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review

Mark Walsh; Ernest E. Moore; Hunter Moore; Scott Thomas; Stefani Vande Lune; David Zimmer; Joseph Dynako; Daniel Hake; Zachary Crowell; Ross McCauley; Emilee E. Larson; Michael Miller; Tim Pohlman; Hardean E. Achneck; Peter Martin; Nathan Nielsen; Faisal Shariff; Victoria A. Ploplis; Francis J. Castellino

doi:10.1055/s-0039-1688497

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2019; 45(04): 354-372
DOI: 10.1055/s-0039-1688497

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review

Mark Walsh

¹Saint Joseph Regional Medical Center, Mishawaka, Indiana

²Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana

³Indiana University School of Medicine, South Bend Campus, South Bend, Indiana

,

Ernest E. Moore

⁴Ernest E. Moore Trauma Center Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado

,

Hunter Moore

⁴Ernest E. Moore Trauma Center Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado

,

Scott Thomas

²Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana

,

Stefani Vande Lune

³Indiana University School of Medicine, South Bend Campus, South Bend, Indiana

,

David Zimmer

³Indiana University School of Medicine, South Bend Campus, South Bend, Indiana

,

Joseph Dynako

³Indiana University School of Medicine, South Bend Campus, South Bend, Indiana

,

Daniel Hake

⁵Chicago College of Osteopathic Medicine at Midwestern University, Downers Grove, Illinois

,

Zachary Crowell

⁵Chicago College of Osteopathic Medicine at Midwestern University, Downers Grove, Illinois

,

Ross McCauley

³Indiana University School of Medicine, South Bend Campus, South Bend, Indiana

,

Emilee E. Larson

³Indiana University School of Medicine, South Bend Campus, South Bend, Indiana

,

Michael Miller

²Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana

,

Tim Pohlman

²Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana

,

Hardean E. Achneck

⁶Haemonetics Corporation, Braintree, Massachusetts

,

Peter Martin

⁷Department of Emergency Medicine, Tulane School of Medicine, New Orleans, Louisiana

,

Nathan Nielsen

⁸Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane School of Medicine, New Orleans, Louisiana

,

Faisal Shariff

³Indiana University School of Medicine, South Bend Campus, South Bend, Indiana

,

Victoria A. Ploplis

⁹W.M. Keck Center for Transgene Research, The University of Notre Dame, Notre Dame, Indiana

¹⁰Department of Chemistry and Biochemistry, The University of Notre Dame, Notre Dame, Indiana

,

Francis J. Castellino

⁹W.M. Keck Center for Transgene Research, The University of Notre Dame, Notre Dame, Indiana

¹⁰Department of Chemistry and Biochemistry, The University of Notre Dame, Notre Dame, Indiana

› Author Affiliations

Abstract

The relationship between malignancy and coagulopathy is one that is well documented yet incompletely understood. Clinicians have attempted to quantify the hypercoagulable state produced in various malignancies using common coagulation tests such as prothrombin time, activated partial thromboplastin time, and platelet count; however, due to these tests' focus on individual aspects of coagulation during one specific time point, they have failed to provide clinicians the complete picture of malignancy-associated coagulopathy (MAC). Viscoelastic tests (VETs), such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are whole blood analyses that have the advantage of providing information related to the cumulative effects of plasma clotting factors, platelets, leukocytes, and red cells during all stages of the coagulation and fibrinolytic processes. VETs have gained popularity in the care of trauma patients to objectively measure trauma-induced coagulopathy (TIC), but the utility of VETs remains yet unrealized in many other medical specialties. The authors discuss the similarities and differences between TIC and MAC, and propose a mechanism for the hypercoagulable state of MAC that revolves around the thrombomodulin–thrombin complex as it switches between activating the protein C anticoagulation pathway or the thrombin activatable fibrinolysis inhibitor coagulation pathway. Additionally, they review the current literature on the use of TEG and ROTEM in patients with various malignancies. Although limited research is currently available, early results demonstrate the utility of both TEG and ROTEM in the prediction of hypercoagulable states and thromboembolic complications in oncologic patients.

Keywords

coagulopathy - thromboembolism - ROTEM - TEG - malignancy - tumors - hypercoagulable

Full Text

References

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