PMID- 9065993
OWN - NLM
STAT- MEDLINE
DCOM- 19970619
LR  - 20041117
IS  - 0340-6245 (Print)
IS  - 0340-6245 (Linking)
VI  - 77
IP  - 3
DP  - 1997 Mar
TI  - Blood coagulation and thrombosis in patients with ovarian malignancy.
PG  - 456-61
AB  - Ovarian cancer cells appear to be capable of both thrombin formation and 
      induction of fibrin degradation which may be essential prerequisites for the 
      development of deep vein thrombosis (DVT) as well as the spread of malignancy. To 
      study further this coagulation-cancer interaction in 60 patients with untreated 
      ovarian cancer of FIGO stage I-IV the incidence of DVT was recorded 
      pre-operatively, post-operatively on day 1, 3, 5, 7, 10, before each of six 
      cycles of Cisplatinum/ Epirubicin/Cyclophosphamide chemotherapy, during follow-up 
      and in the post-operative period of second look surgery. In addition, blood 
      coagulation tests results were determined prospectively. Two patients were 
      excluded from these calculations due to previous DVT 5 to 6 weeks before the 
      diagnosis of ovarian cancer but all patients were eligible for surgery and 
      randomized to receive either daily low molecular weight heparin (LMWH) (n = 28) 
      or unfractionated heparin (UFH) (n = 32) for perioperative thrombosis prophylaxis 
      until the 7th post-operative day. According to the FIGO stage, patients were 
      equally distributed in the 2 heparin treatment groups. The predictive value of 
      pre-operative coagulation test results, clinical parameters, and type of heparin 
      used were tested in univariate and multivariate analysis for development of 
      post-operative DVT and overall patients survival. Impedance plethysmography for 
      DVT screening was used. The presence of DVT was then confirmed by phlebography. 
      Only D-dimer and fibrinogen levels were correlated significantly with the FIGO 
      stage while antithrombin, protein C, and plasminogen activator inhibitor activity 
      were not. The incidence of DVT was 6.7% (4/60) up to the 7th and 8.3% (5/60) 
      between the 8th and 29th post-operative day. DVT occurred in 10.6% (5/47) during 
      chemotherapy. Pre-operative coagulation test results, the type of heparin used, 
      and clinical parameters were not significant risk factors for post-operative DVT 
      development in univariate analysis. The D-dimer and fibrinogen levels were 
      significant risk factors for reduced overall survival in univariate analysis but 
      only the FIGO stage was an independent predictor (in multivariate analysis). 
      After a median follow up of 26.5 months (min. 8 months, max. 41 months), 21.4% of 
      LMWH treated and 37.5% of UFH-treated patients died of cancer (p = 0.26). 
      Pre-operative test results were neither predictive for DVT nor the outcome of 
      cancer but patients showed an improved though not statistically significant 
      overall survival after LMWH treatment.
FAU - von Tempelhoff, G F
AU  - von Tempelhoff GF
AD  - Department of Obstetrics and Gynecology, City Hospital of Ruesselsheim, Germany.
FAU - Dietrich, M
AU  - Dietrich M
FAU - Niemann, F
AU  - Niemann F
FAU - Schneider, D
AU  - Schneider D
FAU - Hommel, G
AU  - Hommel G
FAU - Heilmann, L
AU  - Heilmann L
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - *Blood Coagulation
MH  - Blood Coagulation Tests
MH  - Female
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Middle Aged
MH  - Ovarian Neoplasms/complications/*physiopathology/therapy
MH  - Postoperative Complications/*prevention & control
MH  - Prospective Studies
MH  - Survival Analysis
MH  - Thromboembolism/complications/*prevention & control
EDAT- 1997/03/01 00:00
MHDA- 1997/03/01 00:01
CRDT- 1997/03/01 00:00
PHST- 1997/03/01 00:00 [pubmed]
PHST- 1997/03/01 00:01 [medline]
PHST- 1997/03/01 00:00 [entrez]
PST - ppublish
SO  - Thromb Haemost. 1997 Mar;77(3):456-61.