Correlation between Procoagulant Platelets and Hypercoagulability in Lung Cancer Patients

M. Schreuder^1,2, E.E. Ramsay^1,2, H. Campbell³, J. Simes¹, M. Boyer⁴, A. Joshua^5,6,7, V. Chin^5,6,7, J. Young^8,9,10, B. Brown², V.M. Chen^3,11, P.J. Hogg^2,12

¹The University of Sydney, NHMRC Clinical Trials Centre, Sydney, Australia, ²Sydney Catalyst, The University of Sydney, Sydney, Australia, ³ANZAC Research Institute, The University of Sydney, Sydney, Australia, ⁴Chris O'Brien Lifehouse, Sydney, Australia, ⁵St Vincent's Hospital, Sydney, Australia, ⁶The Kinghorn Cancer Centre, Sydney, Australia, ⁷Garvan Institute of Medical Research, Sydney, Australia, ⁸The University of Sydney, School of Public Health, Sydney, Australia, ⁹Sydney Local Health District, RPA Institute of Academic Surgery, Sydney, Australia, ¹⁰Sydney Local Health District, Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia, ¹¹Concord Repatriation General Hospital, Department of Haematology, Sydney, Australia, ¹²Centenary Institute, The University of Sydney, Sydney, Australia

Abstract Number: LPB0120

Meeting: ISTH 2021 Congress

Theme: Role of Hemostatic System in Cancer, Inflammation and Immunity » Platelets and Cancer

Background: Thrombotic events are a major cause of morbidity and mortality in cancer. The procoagulant subset of platelets have an essential role in triggering coagulation and thrombosis by facilitating surface-dependent reactions. Here, we hypothesize that procoagulant platelet levels could have prognostic significance in cancer, guiding clinical decisions and minimising cancer-associated thrombotic events.

Aims: Investigate the role of procoagulant platelets in lung cancer and evaluate their prognostic value to identify lung cancer patients that are at increased risk for thrombosis.

Methods: Serial, citrated blood samples were collected from a prospective cohort of patients with lung cancer enrolled in the EnRICH (Embedding Research (and Evidence) In Cancer Healthcare) Program, a flagship program of Sydney Catalyst and The University of Sydney. Whole blood was stimulated with platelet agonists (thrombin and collagen) to reveal procoagulant platelets. Samples were labelled and analysed by flow cytometry.

Results: Interim analyses revealed that lung cancer patients (n=117) have significantly higher levels of procoagulant platelets at time of cancer diagnosis relative to healthy volunteers (n=55) and reached peak levels at 6 months after diagnosis. Moreover, lung cancer patients had elevated D-dimer levels at diagnosis compared to healthy controls. Significant associations were found between the level of procoagulant platelets and the Khorana score and thrombotic events during follow-up and trends were observed correlating the formation of procoagulant platelets with cancer progression and overall survival. Conversely, procoagulant platelet levels were comparable in patients with or without a history of thrombosis. Interestingly, procoagulant platelet formation correlated with neutrophil and monocyte count, but not with lymphocyte count.

Conclusions: Collectively, our data suggest that procoagulant platelets correlate with cancer-associated thrombosis and poor prognosis. The increased procoagulant platelet capacity of lung cancer patients may provide novel insights into the risk of thrombotic events in cancer patients. Further collection of data will help to characterise the pathophysiology of thrombosis in cancer.

To cite this abstract in AMA style:

Schreuder M, Ramsay EE, Campbell H, Simes J, Boyer M, Joshua A, Chin V, Young J, Brown B, Chen VM, Hogg PJ. Correlation between Procoagulant Platelets and Hypercoagulability in Lung Cancer Patients [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/correlation-between-procoagulant-platelets-and-hypercoagulability-in-lung-cancer-patients/. Accessed November 30, 2023.

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