Systemic coagulation activation in patients with glioblastoma

Purpose To assess if patients diagnosed with glioblastoma have higher markers of systemic coagulation activation in thrombin generation assay (TGA) and blood tests. Methods We collected preoperative blood samples from 42 glioblastoma patients and 35 healthy controls. We assessed fibrinogen concentration, fibrinogen degradation products (FDP) and D-dimer concentrations, plasminogen activator inhibitor concentration (PAI:Ag), antithrombin (AT) activity, thrombin-antithrombin complexes (TAT), the thrombin peak (P), endogenous thrombin potential (ETP), Lag Time and Time To Peak (TTP). Results Patients with glioblastoma showed higher values of following parameters preoperatively such as D-dimer concentration (1.8 ± 3.6 vs 0.35 ± 0.32 mg/l, p = 0.02), PAI:Ag (27.30 ± 8.90 vs 17.00 ± 9.34, p < 0.01) and TAT (15.20 ± 17.00 vs 4.56 ± 1.66, p < 0.01). Furthermore they showed longer Lag Time (3.50 ± 1.00 vs 3.02 ± 0.69, p = 0.01) and TTP (6.60 ± 1.50 vs 5.73 ± 1.04, p = 0.01) in TGA. Conclusion High values of d-dimer, PAI:AG and TAT concentrations are prothrombotic parameters but longer Lag Time and TTP did not indicate increased systemic coagulation activity. The above information sheds new light on coagulation disorders in glioblastoma patients. This may also indicate that TGA assessed by calibrated automated thrombogram (CAT) has limited ability to detect subtle abnormalities in the coagulation system. In both situations further studies are required.