| Objective: Study on the coagulation index of platelet count(PLT),D-dimmer(D-D),fibrinogen(FIB),activated partial thromboplastin time(APTT)and prothrombin time(PT)in malignancies,investigate the correlation between hypercoagulability and these changes.We compare the difference of these index between tumor and benign diseases to analyze their predictive value and the significance of anticoagulant therapy on thrombosis.Methods: This experiment was based on a retrospective study.We selected 92 cases diagnosed as malignancies from January 2016 to March 2017 in Department of Tumor and Hematology in our hospital,including 47 males and 45 females,with median age of 69(42~75)years old.Of which,26 lung cancer,12 liver cancer,12 colorectal cancer,10 multiple myeloma,9 mammary cancer,8 gastric cancer,6 lymphoma,5 pancreatic cancer,4 renal pelvis cancer.90 cases of first-visit patients of acute myocardial infarction(AMI)in Department of Cardiology at the same time were selected,with median age of 68(45~72)years old,including 46 males and 44 females.89 cases diagnosed as cerebral infarction(CI)at the first time in Department of Neurology in the same period were selected,with median age of 67(50~70)years old,45 males and 44 females.90 Patients diagnosed as community acquired pneumonia by CR or CT and excluding that with recent thrombus events in Department of Respiration at the same time were enrolled in,46 males and 44 females,with median age of 65(40-72)years old.Then we collected their hematology parameters when they were hospitalized,included PLT,D-D,FIB,APTT and PT.The malignancies group was divided into two groups with the boundary of D-D=1.44 ug/ml.D-D<1.44 ug/ml group was treated with antitumor.D-D≥1.44 ug/ml group was treated anticoagulation therapy with inject low molecular weight heparin(LMWH)3000iu once a day for 1 week on the basis of antitumor.Median follow-up time was 6 months and observed the incidence of thrombosis in two groups.The data was analyzed with SPSS20.0,measurement date was expressed by ?X±S.Comparison between groups was tested by one-way ANOVA.The categorical data were tested by chi-square test,P<0.05 was considered to be statistically significant.Results:1.The average PLT、APTT、PT in malignancies was 241.86±135.27×109/L、36.35±2.97s、13.8±2.81 s,respecyively,compared with group AMI,CI and community acquired pneumonia,P>0.05,with no statistical difference in four groups.2.The average level of D-D and FIB in malignancies was2.81±3.25ug/ml and 4.50±1.43g/L,was highest in four groups,P<0.001,with statistical difference.3.Among 92 cases of malignancies,5 had thrombosis,the rate was 5.43%,the common site was deep vein of lower limb,in wich the rate of thrombosis was 80%.All of thrombotic events occurred in D-D≥1.44ug/ml group.4.In 6 months of median follow-up after anticoagula in 48 cases of D-D ≥ 1.44ug/ml group,therewere2 thrombosis,the incidence was 4.17%.While 1 case in group D-D < 1.44ug/ml,the incidence was 2.56%.The two groups were compared with P=0.684,with no statistical difference.Inlustrate that after anticoagulant therapy,the incidence of thrombosis in D-D≥1.44ug/ml group decreased close to the level of D-D < 1.44ug/ml group.Conclusion:1.Patients with malignancies are often accompanied by hypercoagulability,mainly with elevated levels of D-D and FIB.Compared with thrombotic diseases(such as AMI,CI)and infectious diseases,the difference is statistically significant,especially D-D,can be used as the main monitor for hypercoagulability and the clinical predictors of thromboembolism events.2.Thrombosis is common see in deep vein of lower limb in malignancies.With the progress of disease,the incidence of thrombosis is obviously higher when D-D is higher than 1.44ug/ml.3.The anticoagulant therapy of low molecular weight heparin(LMWH)can prevent the occurrence of thrombosis and improve the quality of life in patients with malignancies when D-D≥1.44ug/ml and when D-D < 1.44ug/ml,coagulation index should be followed up regularly. |
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