ELEVATED TFPI IN MALIGNANT DISEASE - RELATION TO CANCER TYPE AND HYPERCOAGULATION

We have previously reported high levels of the coagulation inhibitor T FPI in the blood of patients with gastrointestinal cancer. TFPI is not an acute-phase reactant, but high levels have also been reported in p atients with septicaemia and disseminated intravascular coagulation (D IC). To study its relationship with other types of malignancy, TFPI ac tivity was first determined in plasma samples from 214 patients with v arious malignancies. In a second cohort of 83 patients, total and free TFPI antigen, protein C, antithrombin, fibrin monomer and D-dimer wer e also measured, Elevated TFPI activity and antigens were found in abo ut half of the patients with solid tumours. In contrast, elevated TFPI was rare in haematological malignancies (12%), In the 18 patients wit h acute nonlymphocytic leukaemia (ANLL), elevated free TFPI was found only in patients who also had DIG. No correlation was found between TF PI levels and fibrin monomer or D-dimer levels. Only four out of 20 pa tients with solid tumours had normal levels of fibrin monomer and D-di mer, yet three out of these four had elevated TFPI, In conclusion, ele vated TFPI in ANLL is related to the coexistence of DIG. In solid tumo ur disease increased TFPI may reduce protective fibrin formation, but the pathogenic mechanism is as yet unknown.