(VP011) ASSESSING HYPERCOAGULABILITY AND VTE RISK USING THROMBOELASTOGRAPHY AND KHORANA SCORE IN WOMEN UNDERGOING CHEMOTHERAPY FOR BREAST AND GYNECOLOGICAL CANCERS

Background: Venous thromboembolism (VTE) is a common occurrence in cancer. Thrombosis risk varies according to several cancer and patient-related factors. Chemotherapy increases this risk up to 9-fold. Current VTE risk assessment models such as the Khorana score (KS) and its modifications can identify patients at high risk when undergoing chemotherapy but have limitations. We aimed to assess the global coagulation profile of a group of women diagnosed with cancer and who were starting chemotherapy, to determine whether the hypercoagulable state can inform VTE risk assessment. We also aimed to examine the contribution of other cancer and patient factors to this risk.

METHODS AND RESULTS: A single-center, prospective, longitudinal study. Newly diagnosed cancer patients planned to receive chemotherapy for their cancer were recruited. Blood was collected prior to (sample 1) and after two chemotherapy cycles (samples 2, and 3 respectively). Thromboelastography (TEG) parameters R, K, α, MA, and CI were evaluated. Baseline demographics, cancer data, BMI, KS, and VTE risk factors were recorded. One-way and Repeated Measures ANOVA were used to assess the effect of chemotherapy on those parameters. Patients were followed for 6 months, and any thrombotic events were recorded.

A total of 36 patients aged 35-85 (18 breast, 11 endometrial, 7 ovarian cancer) were evaluated to date. 19.4% patients had metastatic disease, 55.6% patients received platinum-based chemotherapy, 28% of patients had BMI over 30, and 33.3% had comorbidities. Hypercoagulability was detected on TEG in samples 2 and 3 with a significant reduction in R, K, and an increase in α angle, MA, and CI when compared to sample 1 (Table 1). 44.8-70.4% of patients had a hypercoagulable state based on one or more TEG parameters. KS (assessed in 30 patients) showed 7 were low, 21 intermediate and 2 high risk. MA and CI significantly increased in patients with intermediate and high-risk KS when compared to the low-risk patients (Table 2) and MA was significantly correlated with KS (p=0.03). The two parameters were significantly higher in ovarian cancer compared to the other cancer types (P= 0.005, 0.031 respectively). Five patients developed thrombosis (DVT or PE) after chemotherapy; 4 of which were hypercoagulable.

Conclusion: TEG can detect hypercoagulability in cancer patients after chemotherapy and the MA and CI can potentially help improve the application of KS. A larger study is needed to assess the utility of TEG as an adjuvant to KS to predict VTE particularly in specific cancer types.

Funding: CanVECTOR Research Start-Up & SLC Ignite Fund

Lay Abstract Content: BACKGROUND
Blood clot is a common occurrence in cancer. Its risk varies according to several cancer and patient-related factors. Chemotherapy increases this risk up to 9-fold. Current clots risk assessment models such as the Khorana score (KS) and its modifications can identify patients at high risk when undergoing chemotherapy but have limitations. We aimed to assess the global coagulation profile following chemotherapy to determine whether the hypercoagulable state can inform blood clots’ risk assessment. We also aimed to examine the contribution of other cancer and patient factors to this risk.
METHODS
A single-center, prospective, longitudinal study. Newly diagnosed cancer patients who planned to receive chemotherapy for their cancer were recruited. Blood was collected prior to (sample 1) and after two chemotherapy cycles (samples 2, and 3 respectively). Patients were followed for 6 months for any clotting events. A device used to measure clotting parameters called Thromboelastography (TEG) was used. Baseline demographics, cancer data, Body Mass Index, KS, and clotting risk factors were recorded. Paired t-test, One Way and Repeated Measure ANOVA were used to statistically assess the effect of chemo on those parameters.
RESULTS
A total of 36 patients aged 35-85 (18 breast, 11 endometrial, 7 ovarian cancer), with 19.4% metastatic disease were evaluated to date. 55.6% of patients received platinum-based chemotherapy, 28% of patients had BMI over 30, and 33.3% had comorbidities. Increased clotting tendency (hypercoagulability) was detected on TEG in samples 2 and 3 with a significant reduction in 4 testing parameters when compared to sample 1(Table 1). 44.8-70.4% of patients had a hypercoagulable state based on one or more TEG parameters. KS (assessed in 30 patients) showed 7 were low risk, 21 were intermediate and 2 were high risk. Two parameters MA and CI significantly increased in patients with intermediate and high-risk KS when compared to the low-risk patients (Table 2). Five patients developed blood clots in the leg or lungs after chemotherapy; 4 of which were hypercoagulable.

CONCLUSION
TEG can detect hypercoagulability in cancer patients after chemotherapy and the MA and CI can potentially help improve the application of KS. A larger study is needed to assess the utility of TEG as an adjuvant to KS to predict VTE particularly in specific cancer types.