On Tuesday morning, Rienk Nieuland, PhD, a principal investigator of the Academic Medical Centre of the University of Amsterdam, presented a possible new approach to predicting the risk of venous thromboembolism (VTE) in cancer patients. He noted that VTE is effectively treated by prophylactic anticoagulation, but that because anticoagulation increases the bleeding risk, prophylactic treatment of all cancer patients is not desirable. Hence, there is a need to identify cancer patients at high risk of VTE in whom the benefits of thromboprophylaxis may outweight the risks. In describing his group’s work to meet this need, he first noted that saliva contains EVs exposing the protein tissue factor (TF). When we lick a wound, this brings together coagulation factors (blood) and TF (saliva), thereby promoting the clotting of blood. He added that blood from healthy humans does not contain EVs exposing TF, but that circulating EVs exposing TF are encountered during surgery and in several pathologic conditions, including sepsis and cancer. Dr. Nieuwand’s group developed a plasma clotting test (Fibrinogen Generation Test, FGT) in which the clotting time depends on the presence of endogenous EV-associated TF. The ability of the FGT to identify cancer patients at high risk of VTE was determined in a multicenter prospective cohort study. Dr. Nieuwand reported that the results were promising, particularly with regard to pancreatic cancer, and may provide clinically useful information, either as a stand-alone biomarker or when combined with other biomarkers and/or clinical prediction scores for VTE.
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