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A prothrombotic state in breast cancer patients treated with adjuvant chemotherapy

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Abstract

Cancer is often associated with abnormal activation of coagulation leading to a prothrombotic state. Some chemotherapeutic agents used for cancer may induce thrombosis but their biological alterations in the hemostatic system are not yet well understood. This study evaluated alterations of coagulative and fibrinolytic parameters following chemotherapy.

In plasma samples of 38 patients (median age: 49 years) receiving CMF (schedule 1–21 or 1–8) for Stage II breast cancer, we evaluated: PT, aPTT, antithrombin III (AT-III), protein C (PC), protein S (PS), thrombinantithrombin complex (TAT), prothrombin fragment F1 + 2 (F1 + 2), fibrinogen (Fbg), tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI - 1) and D-dimer (D-D). PT, aPTT, and Fbg were determined with routine methods; AT-III, PC, and PS were measured with coagulative tests; PC and PS were also evaluated with immunoenzymatic methods. t-PA, PAI-1, D-D, TAT, and F 1 + 2 were measured with immunoenzymatic methods. All tests were performed immediately before starting therapy and after each cycle.

A PC antigen decrease appeared soon after beginning therapy and lasted throughout chemotherapy. The lowest values were present after the first treatment both in the CMF 1–21 group (mean ± SD = 72.5 ± 10.8%) and in the CMF 1–8 group (mean ± SD = 77.2 ± 6.9%); PC activity was also decreased. PS antigen decreased after the first administration (mean ± SD = 73.3 ± 10% in CMF 1–21 group, and 72.5 ± 4.9% in CMF 1–8 group); PS activity also decreased. PAI-1 antigen levels increased (mean ± SD = 43.1 ± 20.4 ng/ml in the CMF 1–21 group, and 37.5 ± 12.2 ng/ml in CMF 1–8 group) lasting up to the last cycle.

CMF provokes a trend toward hypercoagulability; this effect should be considered when chemotherapy is employed in advanced cancer patients at high risk for thrombosis, or in patients with other risk factors.

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Authors and Affiliations

  1. Hemostasis and Hematology Laboratory, Oncology Institute, Via Amendola 209, 70126, Bari, Italy

    Francesco Giotta, Evaristo Maiello & Giuseppe Colucci

  2. Medical Division, Oncology Institute, Bari, Italy

    Francesco Schittulli

  3. Surgical Senology Division, Oncology Institute, Bari, Italy

    Carmela Rella, Maria Coviello, Paolo Colavito, Donatella Colangelo & Michele Quaranta

Authors
  1. Carmela Rella
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  2. Maria Coviello
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  3. Francesco Giotta
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  4. Evaristo Maiello
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  5. Paolo Colavito
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  6. Donatella Colangelo
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  7. Michele Quaranta
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  8. Giuseppe Colucci
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  9. Francesco Schittulli
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Additional information

C.R. is a recipient of a fellowship from the Italian Association for Cancer Research (A.I.R.C.)

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Rella, C., Coviello, M., Giotta, F. et al. A prothrombotic state in breast cancer patients treated with adjuvant chemotherapy. Breast Cancer Res Tr 40, 151–159 (1996). https://doi.org/10.1007/BF01806210

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