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Study Examines Impact of ADAMTS-13 and von
Willebrand Factor on Predicting VTE in Cancer
Patients
Patients with cancer are at high
risk for developing venous thromboembolism (VTE), and the risk
is much higher if the patient has
higher von Willebrand factor
(vWF) and ADAMTS-13 activity
levels, according to results from
a case-control study published
in the Journal of Thrombosis and
Haemostasis by Marion Pépin,
from the Hôpital Louis Mourier
in France, and colleagues. Adding
these factor level measurements
to a clinical prediction tool for
VTE increased the tool’s predictive
value, as well.
Dr. Pépin and co-authors analyzed data from an ongoing, multicenter, international, prospective cohort study of consecutive
ambulatory patients with recently
diagnosed cancer to investigate the
predictive value of parameters for
the occurrence of VTE.
Adult patients were included
in the study if they had a histologically confirmed diagnosis of solid
organ cancer stage III or IV or
tumor progression after a remission
period. Chemotherapy was initiated
within three months prior to study
inclusion and up to one week after
inclusion, though patients receiving
therapeutic anticoagulant treatment
or adjuvant chemotherapy were
excluded.
The study included 160
patients: 20 cases (patients with
cancer and VTE) and 140 controls
(patients with cancer but no VTE).
The mean patient age was 61.9
years, and the majority of patients
were male (68.1%; n=109). Within
the case cohort, most patients developed VTE after a median of 2.2
months, and VTE was symptomatic in a majority of these patients
(55%).
Patients’ risk for VTE was
calculated using the Khorana
score and the Vienna Cancer and
Thrombosis Study (CATS) score,
which are clinical prediction tools
that incorporate the following
biomarkers that are associated
with VTE risk: soluble P-selectin
ASHClinicalNews.org
(sP-sel), factor VIII, and D-dimer
or prothrombin fragment 1 + 2
(F1 + 2).
Once risk scores were calculated, patients were stratified as:
• Low risk: score = 0
• Intermediate risk: score = 1-2
• High risk: score = ≥3
See TABLE 1 for ADAMTS-13 and
vWF levels in both patient cohorts.
ADAMTS-13 (activity or
antigen) levels were in the normal
range (50-150% and 400-1200 ng/
mL, respectively) and not significantly different between cases and
controls, even after adjustment for
vWF levels. However, vWF levels
were increased in all patients, and
VTE patients had higher levels
(326 IU/mL) compared with cancer patients without VTE (242 IU/
mL; p=0.02). This difference remained significant when adjusting
for ADAMTS-13 levels (p=0.02).
High vWF levels (>290 IU/mL)
were found to be independently
assoc