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Increased acquired activated protein C resistance in unselected patients with hematological malignancies
Author(s) -
NEGAARD H. F. S.,
IVERSEN P. O.,
ØSTENSTAD B.,
MOWINCKEL M. C.,
SANDSET P. M.
Publication year - 2008
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2008.03060.x
Subject(s) - medicine , protein c , activated protein c resistance , cancer , myeloid leukemia , multiple myeloma , lymphoma , gastroenterology , hematology , cancer research , immunology , oncology , thrombosis , venous thrombosis , factor v leiden
Summary. Background: We have previously found that activation of coagulation in patients with various hematological malignancies was apparently not initiated by tissue factor (TF). Acquired activated protein C (APC) resistance may be another mechanism responsible for such hypercoagulation, and has been demonstrated in patients with solid tumors, but not in patients with hematological malignancy. Objective: To investigate acquired APC resistance in a hypercoagulable cohort of patients with hematological malignancies. Patients/methods: Blood samples from 93 patients with acute myeloid leukemia (AML), chronic lymphatic leukemia, multiple myeloma, or non‐Hodgkin’s lymphoma, were analyzed before start and after completion of cancer therapy. APC resistance was measured using calibrated automated thrombography. The APC sensitivity ratio (APC‐SR) was calculated as the ratio of the endogenous thrombin potential (ETP) determined in plasma probed with either APC or buffer. Results: Untreated patients were found to have higher APC‐SR than healthy controls, and patients with AML had higher APC‐SR as compared to the other diagnoses, both findings being consistent with acquired APC resistance. The acquired APC resistance was partly ameliorated with cancer treatment. Decreased levels of protein S and TF pathway inhibitor were inversely correlated to APC resistance. Conclusions: APC resistance may contribute to the hypercoagulable state in hematological malignancies.