Thrombosis and bemorbeology in patients with breast cancer and adjuvant chemotherapy

Abstract

We examined 43 women with stage II breast cancer receiving adjuvant Epirubicin / Cyclophosphamid chemotherapy. Preoperatively and before each of six cycles of chemotherapy erythrocyte aggregation (stasis and low shear), plasma viscosity, hematocrit, platelets, leukocytes and fibrinogen levels were estimated and impedance plethysmography (IPG) was performed for screening of deep vein thrombosis (DVT). We observed 5 DVT (11.6 %) during chemotherapy. These patients were significantly older than patients without DVT. Preoperatively, all cancer patients demonstrated a hyperviscosity state which was most pronounced in DVT patients and characterized by a significantly elevated plasma viscosity, erythrocyteaggregation and fibrinogen levels. Mean fibrinogen levels were significant correlated with plasma viscosity in all cancer patients (r = 0.38; p < 0.0001). Platelets, leukocytes as well as hematocrit showed no pathologic changes in cancer patients and did not contribute to the hyperviscosity state. Throughout chemotherapy only fibrinogen levels showed a further significant increase versus patients without DVT. Although preoperative erythrocyte aggregation offered the best prediction (specitivity: stasis 92 %, low shear 97 %; neg. prediction: 92 % respectively 90%) from all estimated rheological parameters-for later DVT the clinical importance is of limited value. All DVTs were detected by IPG and a normal result excluded DVT in 100 % of the cases.