BLOOD-COAGULATION AND THROMBOSIS DURING A DJUVANT CISPLATIN EPIRUBICIN/CYCLOPHOSPHAMIDE CHEMOTHERAPY IN PATIENTS WITH PRIMARY OVARIAN-CANCER/

Chemotherapy can be an independent risk factor for the development of deep vein thrombosis (DVT) in gynaecological cancer patients. Prospect ively, before, during and after first line Cisplatinum/Epirubicin/Cycl ophosphamide chemotherapy serial coagulation tests were performed and the incidence of DVT was recorded in 47 patients with ovarian cancer o f FIGO stage Ib-IV. Coagulation estimations included fibrinogen (metho d of Clauss), D-dimer (ELISA test), protein C, antithrombin (chromogen ic substrate test) and plasminogen activator inhibitor activity (PAI a ct.) (uPA dependent inhibition test). Impedance plethysmography (IPG) was used for DVT screening. The presence of DVT was then confirmed by phlebography. IPG and coagulation tests took place before primary surg ery, before each of 6 cycles of chemotherapy and 2 months thereafter. Only six patients with previous DVT in the pre-and postoperative perio d respectively received anticoagulation during chemotherapy (once 3000 anti Xa Units/day s.c. low molecular weight heparin; Mono Embolex, NO VARTIS). During chemotherapy, the phlebographically proven DVT inciden ce was 10.6%; 95% CI: 3.5-23.1 (n=3 after 1(st) cycle; n=1 after 2(nd) cycle; n=l after 4(th) cycle). Patients who developed DVT were signif icantly order than those who did not. No correlation for DVT-developme nt and the FIGO stage existed. Neither preoperative nor pre-chemothera py coagulation test results were significantly different in patients w ith or without later DVT development. However, pre-and postoperative ( = before chemotherapy) mean revels of the D-dimer and fibrinogen were markedly above the normal range, but significantly decreased during ch emotherapy without reaching the normal range. Post-operatively median PA[ act. slightly increased above normal and remained elevated through out chemotherapy. Preoperatively and during chemotherapy, levels of an tithrombin and protein C were within the normal range. Two patients wi th DVT during chemotherapy had decreased protein C levels and markedly elevated PAI act. before the beginning of chemotherapy. Coagulation t ests performed serially in this study did not identify patients at hig her risk for DVT development during chemotherapy. None of the patients who concomitantly received anticoagulation during chemotherapy develo ped rethrombosis. The question arises whether ovarian cancer patients should routinely receive thrombosis prophylaxis during chemotherapy.