Thromboelastography, thrombin generation test and thrombodynamics reveal hypercoagulability in patients with multiple myeloma

Abstract

Patients with multiple myeloma (MM) are at increased risk of venous thromboembolism. Therefore, adequate laboratory control of hemostasis and subsequent adjustments of anticoagulant therapy are necessary. We studied hemostasis changes using thromboelastography (TEG), thrombin generation test (TGT) and thrombodynamics (TD) in primary MM patients (PMMpt, n = 25) and patients in remission (RMMpt, n = 34) during blood stem cell (BSC) mobilization. TD and TEG reveal hypercoagulability in PMMpt (*p < 0.05) in relation to healthy volunteers. There was no difference in any of the tests between PMMpt and RMMpt. We detected no heparin effect in 22% of patients one day after the onset of the prophylactic heparin treatment (500 IU/h) during BSC mobilization; tests shifted toward the hypercoagulability in 75% of patients one day after cyclophosphamide (4 g/m²) chemotherapy. Global hemostasis tests were in good agreement with each other, revealed hypercoagulability and heparin “resistance” in patients with MM and may be useful for therapy individualization.

Keywords::

• Chemotherapy
• hypercoagulability
• multiple myeloma
• thrombin generation test
• thrombodynamics
• thromboelastography

Acknowledgements

This work was supported by RFBR grants 14-04-00670, 14-04-31055, 13-04-00401a and by the Russian Academy of Sciences Presidium Basic Research Programs “Molecular and Cellular Biology”, “Basic Science for Medicine”, “Integrative Physiology”, and “Molecular Mechanisms of Physiologic Functions”.

Potential conflict of interest

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Supplementary material available online

Supplementary Tables I–IV and Figures 1 and 2