Markers of activated hemostasis and fibrinolysis in patients with pulmonary malignancies: Comparison of plasma levels in central venous and pulmonaryvenous blood

Malignancy frequently is accompanied by activated coagulation and fibrinoly sis indicating a hypercoagulable state. The purpose of our study was to est imate the contribution of local tumor-induced mechanisms to the activation of hemostasis and fibrinolysis. In a prospective study, we compared the pla sma levels of thrombin-antithrombin complexes, prothrombin fragment 1+2, an d D-dimers in blood samples that simultaneously were drawn from the superio r vena cava and the pulmonary vein of a tumor-bearing pulmonary lobe. Sampl es from the superior vena cava were drawn before operation and served as co ntrols. After thoracotomy, a second group of samples was simultaneously tak en from the pulmonary veins of the tumor-bearing lobe and the superior vena cava. Forty-five patients with pulmonary malignancies were included (25 ad enocarcinomas and 20 squamous cell carcinomas). There were no significant d ifferences of thrombin-antithrombin complexes, prothrombin fragment 1+2, an d D-dimers levels in patients suffering from adenocarcinoma and from squamo us cell carcinoma. Intraoperatively, prothrombin fragment 1+2 and D-dimers levels were markedly increased when compared with the preoperative values ( p < 0.0001). There was no increase of thrombin-antithrombin complexes level s due to the operative traumatization. Prothrombin fragment 1+2, thrombin-a ntithrombin complexes, and D-dimers plasma levels were significantly higher in the pulmonary venous blood than in the blood simultaneously drawn from the superior vena cava (p < 0.0001). Our findings indicate that malignant l ung tumors directly contribute to the activation of hemostasis and fibrinol ysis in these clinical settings. (C) 2000 Elsevier Science Ltd. All rights reserved.