Video-assisted Thoracoscopic surgery (VATS) lobectomy for lung cancer does not induce a procoagulant state

Thomas Decker Christensen, Henrik Vad, Søren Pedersen, Peter B Licht, Mads Nybo, Kåre Hornbech, Nora Elisabeth Zois, Anne-Mette Hvas, Thomas Decker Christensen, Henrik Vad, Søren Pedersen, Peter B Licht, Mads Nybo, Kåre Hornbech, Nora Elisabeth Zois, Anne-Mette Hvas

Abstract

Background: Changes in the coagulation system in patients undergoing surgery for lung cancer have been sparsely investigated and the impact of the surgical trauma on the coagulation system is largely unknown in these patients. An increased knowledge could potentially improve the thromboprophylaxis regimes. The aim of this study was to assess the coagulation profile evoked in patients undergoing curative surgery by Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer.

Methods: Thirty-one patients diagnosed with primary lung cancer undergoing VATS lobectomy were prospectively included. The coagulation profile was assessed preoperatively and in the first two days postoperatively using a wide range of standard coagulation tests, dynamic whole blood coagulation measured by rotational thromboelastometry (ROTEM®) and thrombin generation evaluated by calibrated automated thrombography. Patients did not receive thromboprophylactic treatment. Data was analyzed using repeated measures one-way ANOVA.

Results: The standard coagulation parameters displayed only subtle changes after surgery and the ROTEM® and thrombin generation results remained largely unchanged.

Conclusions: Patients undergoing VATS lobectomy are normocoagulable in the preoperative state and a VATS lobectomy does not significantly influence the coagulation.

Trial registration: The trial is registered at ClinicalTrials.gov (Identifier: NCT01741506) and at EudraCTno. 2012-002409-23. Registered December 2012.

Keywords: Blood coagulation; Blood coagulation test; Lung neoplasm; Thoracic surgery; Venous thrombosis; Video assisted.

Conflict of interest statement

The patients were included after oral and written consent. The study protocol complied with the Helsinki II declaration and was approved by the local scientific ethical committee (File number: 1–10–72-364-12) and The Danish Data Protection Agency. The study was conducted according to Good Clinical Practice (GCP) standards and was monitored and approved by the GCP-unit, Aarhus University Hospital, Aarhus, Denmark. The trial is registered at ClinicalTrials.gov (Identifier: NCT01741506) and at EudraCTno. 2012–002409-23.Not applicableThomas Decker Christensen has been on the speaker bureaus for AstraZeneca, Boehringer-Ingelheim, Pfizer, Roche Diagnostics, Takeda, Bristol-Myers Squibb and Merck Sharp & Dohme (MSD) and has been in an Advisory Board for Bayer, Merck Sharp & Dohme (MSD) and Boehringer-Ingelheim. Anne-Mette Hvas has received speaker’s fees from CSL Behring, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb and Leo Pharma and unrestricted research support from Octapharma, CSL Behring and Leo Pharma. Mads Nybo has received speaker’s fees from Astra Zeneca, Pfizer, Boehringer-Ingelheim, and Roche Diagnostics. Peter Licht has received speaker’s fees from Ethicon Endo-Surgery. Other authors – none declared.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Trial flowchart for patients planned for Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer. The number of patients assessed for eligibility is not shown. Abbreviations: n/N: numbers; ASA: Acetylsalicylic acid (aspirin); LMWH: Low-Molecular-Weight Heparin; NSAID: Non Steroid Anti Inflammatory Drug
Fig. 2
Fig. 2
Conventional coagulation tests among 31 patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for lung cancer. The p – values for the result of the ANOVA test are displayed. Values are shown as mean and standard deviation (SD), and dotted lines display the normal range (mean +/− 1.97 * SD) for healthy subjects established by the Department of Clinical Biochemistry, Aarhus University Hospital, Denmark. Abbreviations: APTT = Activated partial thromboplastin time INR = International Normalized Ratio
Fig. 3
Fig. 3
Rotem® results among 31 patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for lung cancer. The p – values for the result of the ANOVA test are displayed. Values are shown as mean and standard deviation (SD), and dotted lines display the normal range (mean +/− 1.97 * SD) [12]. Abbreviations: CT = Clotting Time MaxVel = Maximum Velocity tMaxVel = Time to Maximum Velocity MCF = Maximum Clot Firmness
Fig. 4
Fig. 4
Thrombin generation among 31 patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for lung cancer. The p – values for the result of the ANOVA test are displayed. Values are shown as mean and standard deviation (SD), and dotted lines display the normal range (mean +/− 1.97 * SD) [13]

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