Preoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non-spinal skeletal metastases
Abstract Background Thrombotic complications are synergistic and associated with orthopedic procedures, trauma, and malignancy. Because cancer enhances coagulation activity and vice versa, we assessed preoperative biomarkers for survival and complications after treatment of pathologic fractures in n...
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | Thrombosis Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12959-022-00431-w |
| _version_ | 1811215925381169152 |
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| author | Sanna Matilainen Gilber Kask Jyrki Nieminen Riitta Lassila Minna Laitinen |
| author_facet | Sanna Matilainen Gilber Kask Jyrki Nieminen Riitta Lassila Minna Laitinen |
| author_sort | Sanna Matilainen |
| collection | DOAJ |
| description | Abstract Background Thrombotic complications are synergistic and associated with orthopedic procedures, trauma, and malignancy. Because cancer enhances coagulation activity and vice versa, we assessed preoperative biomarkers for survival and complications after treatment of pathologic fractures in non-spinal skeletal metastases. Patients/methods Our study population comprised 113 actual or impending pathologic fractures in 100 patients admitted to two referral centers. Laboratory variables were collected retrospectively from patient records and analyzed related to incidence of pulmonary embolism (PE) and mortality (Kaplan-Meier and Cox regression analyses and biomarker quartiles). Results Preoperative coagulation variables were high without exceptions. PE occurred in 12 patients at 36 post-operative days at incidence of 11% in the lower and 13% in the upper extremity fractures. Patients with fibrinogen exceeding 5 g/l (log-rank 0.022) developed PE earlier (5 to 15 days postoperatively) than others. Also, mean patient survival with normal fibrinogen range (2–4 g/l) was 34 months, whereas it halved upon elevated fibrinogen (log-rank p = 0.009). Survival in patients with FVIII levels under 326 IU/dl (Q3) was 22 months, but only 7 months if FVIII exceeded 326 IU/dl (log-rank p = 0.002). Combined elevated fibrinogen and FVIII predicted survival: for patients with levels below threshold limits was 22 months versus only 7 months when both variables exceeded the ranges (log-rank p < 0.001). Multivariate analysis to control confounders supported an independent role of fibrinogen and FVIII for survival. Conclusions Our study has established fibrinogen and FVIII as potential preoperative contributors of survival and complications after treatment of metastatic fractures. These results highlight the need for novel anticoagulation and thromboprophylaxis strategies among these patients. |
| first_indexed | 2024-04-12T06:31:32Z |
| format | Article |
| id | doaj.art-8057a3cd0d5d461a93b61db33c59a212 |
| institution | Directory Open Access Journal |
| issn | 1477-9560 |
| language | English |
| last_indexed | 2024-04-12T06:31:32Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Thrombosis Journal |
| spelling | doaj.art-8057a3cd0d5d461a93b61db33c59a2122022-12-22T03:44:01ZengBMCThrombosis Journal1477-95602022-11-0120111010.1186/s12959-022-00431-wPreoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non-spinal skeletal metastasesSanna Matilainen0Gilber Kask1Jyrki Nieminen2Riitta Lassila3Minna Laitinen4Department of Orthopedics and Traumatology, Lohja Hospital, Helsinki University Hospital, University of HelsinkiDepartment of Orthopedics and Traumatology, Helsinki University Hospital, University of HelsinkiCoxa, Hospital for Joint ReplacementCoagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Center, Research Program Unit of Systems Oncology, Oncosys University of HelsinkiDepartment of Orthopedics and Traumatology, Helsinki University Hospital, University of HelsinkiAbstract Background Thrombotic complications are synergistic and associated with orthopedic procedures, trauma, and malignancy. Because cancer enhances coagulation activity and vice versa, we assessed preoperative biomarkers for survival and complications after treatment of pathologic fractures in non-spinal skeletal metastases. Patients/methods Our study population comprised 113 actual or impending pathologic fractures in 100 patients admitted to two referral centers. Laboratory variables were collected retrospectively from patient records and analyzed related to incidence of pulmonary embolism (PE) and mortality (Kaplan-Meier and Cox regression analyses and biomarker quartiles). Results Preoperative coagulation variables were high without exceptions. PE occurred in 12 patients at 36 post-operative days at incidence of 11% in the lower and 13% in the upper extremity fractures. Patients with fibrinogen exceeding 5 g/l (log-rank 0.022) developed PE earlier (5 to 15 days postoperatively) than others. Also, mean patient survival with normal fibrinogen range (2–4 g/l) was 34 months, whereas it halved upon elevated fibrinogen (log-rank p = 0.009). Survival in patients with FVIII levels under 326 IU/dl (Q3) was 22 months, but only 7 months if FVIII exceeded 326 IU/dl (log-rank p = 0.002). Combined elevated fibrinogen and FVIII predicted survival: for patients with levels below threshold limits was 22 months versus only 7 months when both variables exceeded the ranges (log-rank p < 0.001). Multivariate analysis to control confounders supported an independent role of fibrinogen and FVIII for survival. Conclusions Our study has established fibrinogen and FVIII as potential preoperative contributors of survival and complications after treatment of metastatic fractures. These results highlight the need for novel anticoagulation and thromboprophylaxis strategies among these patients.https://doi.org/10.1186/s12959-022-00431-wFibrinogenFVIIIPathological fractureThromboprophylaxisSkeletal metastasis |
| spellingShingle | Sanna Matilainen Gilber Kask Jyrki Nieminen Riitta Lassila Minna Laitinen Preoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non-spinal skeletal metastases Thrombosis Journal Fibrinogen FVIII Pathological fracture Thromboprophylaxis Skeletal metastasis |
| title | Preoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non-spinal skeletal metastases |
| title_full | Preoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non-spinal skeletal metastases |
| title_fullStr | Preoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non-spinal skeletal metastases |
| title_full_unstemmed | Preoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non-spinal skeletal metastases |
| title_short | Preoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non-spinal skeletal metastases |
| title_sort | preoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non spinal skeletal metastases |
| topic | Fibrinogen FVIII Pathological fracture Thromboprophylaxis Skeletal metastasis |
| url | https://doi.org/10.1186/s12959-022-00431-w |
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