Prethrombosis dan Hiperkoagulabilitas pada Pasien Kanker Paru yang Kemoterapi

Abstract

Background: There was evidence to suggest that in case of malignancies and probably also in lung cancer, there is increased state of hypercoagulability. In spite of this, it is still not clear whether the risk is altered by the course of chemotherapy. The Aim of the Study: Therefore, this study is to investigate whether there is state of pre-thrombosis and hypercoagulability in patients with lung cancers and the underlying effect of chemotherapy during the course of the treatment. Materials and Methods: 12 lung cancer patients were recruited. Their stages and clinical performances were determined. Blood sample was taken before the

chemotherapy, immediately after the first-, and immediately after the third- chemotherapy cycles, for the investigation of D-dimer, platelet count, PT (INR),

ratios of APTT and TT. The chemotherapy protocols vary from one patient to the others as well as between the 1

st and the 3rd chemotherapy regimens although most of the protocol consists of carboplatin + gemcitabine or carboplatin + paclitaxel. From the thrombosis view point, they were all asymptomatic and remained so during the period of investigation. Thrombosis is defined as increase of D-dimer, and hypercoagulability as finding of one or more of PT (INR), ratio APTT, ratio TT <LO.The trend of the result in the three sampling points is carried out by ANNOVA, while uni-variate analysis between two investigation is done by Wilcoxon test for small sample. Results: The result of PT, APTT and TT indicating hypercoagulability showed that they remained unchanged before the chemotherapy all the way till the third cycle of chemotherapy (p>0.05). The platelets of the overall patients dropped significantly; median (range) 422 to 287 x 109

/1 before the chemotherapy to the end of third cycle respectively. The D-Dimer of overall patients remained unchanged, however when it is investigated by uni-variate analysis in the group with D-Dimer >500 ng/ml, this group showed a reduction of D-Dimer towards the end of the third cycle (p <0.05). Conclusion: This study demonstrated that there is hypercoagulability in patients with lung cancers all the way starting before the chemotherapy until the 3 rd cycle of chemotherapy, which hypercoagulability was not altered by the course of chemotherapy. However, in the group where pre-thrombosis is already happened as evidenced by high D-dimer (>500 ng/ml) the chemotherapy showed benefit in terms of reduction of the D-dimer which may lead to the possible breakdown of the existing thrombus