Coagulation parameters in gastrointestinal cancer patients with venous thromboembolism

BACKGROUND: Patients with gastrointestinal (GI) cancer are at increased risk of venous thromboembolism (VTE), which is an important cause of mortality. Risk stratification of VTE in GI cancer remains challenging. OBJECTIVES: To investigate whether assessment of the coagulation system can predict VTE risk in three GI tumor types. METHODS: We used a nested case-control design within the MICA cohort (total N = 81), including 27 patients who developed VTE during follow-up and 54 matched non-VTE controls. The subgroup distribution was esophageal cancer (n = 42), pancreatic cancer (n = 18), and colorectal cancer (n = 21). Plasma samples were analyzed using a multifaceted approach incorporating tissue factor (TF) measurement, thrombin generation, and endothelial function testing within an artificial vessel model. Conditional logistic regression was used to evaluate associations between coagulation parameters and VTE risk. RESULTS: TF concentrations did not differ between patients with and without VTE across esophageal, colorectal, and pancreatic cancers. In esophageal cancer, prolonged lag time, as well as higher endogenous thrombin potential and peak values in the artificial vessel model, were significantly associated with an increased risk of VTE (OR = 9.95, 95% CI 1.21-81.54; OR = 5.15, 95% CI 1.07-25.00; OR = 10.75, 95% CI 1.31-90.91). No significant differences in coagulation-related parameters were observed in pancreatic or colorectal cancer patients. CONCLUSION: Abnormal coagulation may be associated with VTE risk mainly in esophageal cancer, suggesting that VTE biomarkers may differ by cancer type and require further investigation in larger cohorts.