Summary
Purpose
To evaluate the effect of standard chemotherapeutic regimens on the hemostatic profile
of patients with breast and lung carcinoma; and to evaluate the effect of a single
dose of a low molecular weight (LMW) heparin, dalteparin sodium, administered prior
to the chemotherapy on markers of hemostatic activation.
Patients and Methods
11 patients with breast cancer and 10 patients with lung cancer receiving systemic
chemotherapy were studied. 10 breast cancer patients and 9 lung cancer patients completed
at least 1 cycle of treatment and had all hemostatic studies. Patients had a complete
hemostatic and prothrombotic profile performed at study initiation. Markers of hemostatic
activation consisting of immunoassays for thrombin-antithrombin (TAT) complex and
D-dimer were measured in plasma samples obtained prior to chemotherapy and at 1, 24
and 48 h after treatment. A 2500 U dose of dalteparin was given prior to the 2nd cycle
of chemotherapy; 5000 U of dalteparin was given prior to the 4th treatment cycle.
Results
Chemotherapy resulted in statistically significant increases in TAT and D-dimer for
the 1, 24 and 48 h plasma samples in both the breast and lung cancer patients for
all cycles of chemotherapy given without LMW heparin. There were statistically significant
increases in basal thrombin generation over the 4 cycles of treatment which was unrelated
to active cancer. Both pretreatment doses of dalteparin effectively prevented increases
in the markers of hemostatic activation. However, in the lung cancer patients, who
had significantly increased basal thrombin generation, the 5000 U dose dalteparin
was more effective.
Conclusion
Chemotherapy results in significant hemostatic activation in patients with breast
and lung cancer. The effect of treatment appears to be cumulative. A single dose of
LMW heparin administered prior to therapy can suppress hemostatic activation.
This project was funded by a grant from the Pharmacia corporation
Keywords
Cancer - chemotherapy - hemostatic activation - thrombosis