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Comparative Study
. 2018 Jul;24(5):755-763.
doi: 10.1177/1076029617724229. Epub 2017 Sep 5.

Comparison Between Thromboelastography and Conventional Coagulation Tests in Surgical Patients With Localized Prostate Cancer

Zhengwei Wang  1 , Jing Li  2 , Qingwei Cao  3 , Lei Wang  1 , Fengzhi Shan  1 , Houyi Zhang  4
Affiliations
Comparative Study

Comparison Between Thromboelastography and Conventional Coagulation Tests in Surgical Patients With Localized Prostate Cancer

Zhengwei Wang et al. Clin Appl Thromb Hemost. 2018 Jul.

Abstract

We aimed to examine hypercoagulable and hypocoagulable conditions in patients with prostate cancer using thromboelastography (TEG) and correlate TEG parameters with conventional coagulation test. The t test was used for comparing TEG parameters and routine coagulation results. Spearman rank-order correlation was used to describe the relationship of TEG and conventional tests. Sensitivity, specificity, positive predictive values, and negative predictive values were determined for bleeding and thrombosis. Totally, 20 patients had active bleeding postoperatively, 16 of whom showed hypocoagulation on TEG test and 9 of whom showed hypocoagulation by routine coagulation test ( P = .024). Overall, 60 patients did not have active bleeding postoperatively, 51 of whom showed hypercoagulation detected by TEG test and 42 of whom showed hypercoagulation found by routine coagulation test ( P = .040). Remarkably, patients had a little higher fibrinogen (FIB) compared to controls. There was no statistical difference in any of the conventional coagulation indexes between the groups. Correlation analysis showed that reaction time (R) and coagulation time (K) were positively correlated with the prothrombin time-international normalized ratio (PT-INR) and negatively correlated with FIB ( P < .001). Contrarily, α-angle and maximum amplitude (MA) were negatively correlated with PT-INR but positively correlated with FIB. Significantly, MA showed the strongest correlation with FIB and R exhibited the strongest correlation with PT-INR. Sensitivity and specificity for bleeding and thrombosis in TEG were higher than those in conventional coagulation test. Accordingly, TEG might be superior in evaluating hypercoagulation and detecting the risk of bleeding in patients with prostate cancer.

Keywords: coagulation function; correlation; prostate cancer; routine coagulation test; thrombelastography.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Normal thromboelastography (TEG) tracing and reference ranges for parameters in TEG test. α angle indicates the rate of clot formation; CI, coagulation index; K, coagulation time; LY30, clot lysis at 30 minutes; MA, maximum amplitude; R, reaction time.
Figure 2.
Figure 2.
Representative normal (A), hypocoagulable (B), and hypercoagulable (C) thromboelastography (TEG) traces.
Figure 3.
Figure 3.
The correlation between R and K value with PT-INR and FIB. A, R value was significantly positively related to PT-INR. B, R value was significantly negatively correlated with FIB. C, K value was significantly positively related to PT-INR. D, K value was significantly negatively correlated with FIB. FIB indicates fibrinogen; K, coagulation time; MA, maximum amplitude; PT-INR, prothrombin time–international normalized ratio; R, reaction time.
Figure 4.
Figure 4.
The correlation between α-angle and MA with PT-INR and FIB. A, α-Angle was significantly positively related to PT-INR. B, α-Angle was significantly negatively correlated with FIB. C, The MA was significantly positively related to PT-INR. D, The MA was significantly negatively correlated with FIB. FIB indicates fibrinogen; K, coagulation time; MA, maximum amplitude; PT-INR, prothrombin time–international normalized ratio; R, reaction time.
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