BLOOD-COAGULATION AND THROMBOSIS IN PATIENTS WITH OVARIAN MALIGNANCY

Ovarian cancer cells appear to be capable of both thrombin formation a nd induction of fibrin degradation which may be essential prerequisite s for the development of deep vein thrombosis (DVT) as well as the spr ead of malignancy. To study further this coagulation - cancer interact ion in 60 patients with untreated ovarian cancer of FIGO stage I-IV th e incidence of DVT was recorded pre-operatively, post-operatively on d ay 1, 3, 5, 7, 10, before each of six cycles of Cisplatinum/Epirubicin /Cyclophosphamide chemotherapy, during follow-up and in the post-opera tive period of second look surgery. In addition, blood coagulation tes ts results were determined prospectively. Two patients were excluded f rom these calculations due to previous DVT 5 to 6 weeks before the dia gnosis of ovarian cancer but all patients were eligible for surgery an d randomized to receive either daily low molecular weight heparin (LMW H) (n = 28) or unfractionated heparin (UFH) (n = 32) for perioperative thrombosis prophylaxis until the 7th postoperative day. According to the FIGO stage, patients were equally distributed in the 2 heparin tre atment groups. The predictive value of pre-operative coagulation test results. clinical parameters, and type of heparin used were tested in univariate and multivariate analysis for development of post-operative DVT and overall patients survival. Impedance plethysmography for DVT screening was used. The presence of DVT was then confirmed by phlebogr aphy. Only D-dimer and fibrinogen levels were correlated significantly with the FIGO stage while antithrombin, protein C, and plasminogen ac tivator inhibitor activity were not. The incidence of DVT was 6.7% (4/ 60) up to the 7th and 8.3% (5/60) between the 8th and 29th post-operat ive day. DVT occurred in 10.6 % (5/47) during chemotherapy. pre-operat ive coagulation test results. the type of heparin used, and clinical p arameters were not significant risk factors for post-operative DVT dev elopment in univariate analysis. The D-dimer and fibrinogen levels wer e significant risk factors for reduced overall survival in univariate analysis but only the FIGO stage was an independent predictor (in mult ivariate analysis). after a median follow up of 26.5 months (min. 8 mo nths, max. 41 months). 21.4% of LMWH treated and 37.5% of UFH-treated patients died of cancer (p = 0.26). Pre-operative test results were ne ither predictive for DVT nor the outcome of cancer but patients showed an improved though not statistically significant overall survival aft er LMWH treatment.