Significance and Prognostic Value of The Coagulation Profile in Patients with Glioblastoma: Implications for Personalized Therapy

• Published in: World neurosurgery 2019-01, Vol.121, p.e621-e629
• Main Authors: Navone, Stefania Elena, Guarnaccia, Laura, Locatelli, Marco, Rampini, Paolo, Caroli, Manuela, La Verde, Nicla, Gaudino, Chiara, Bettinardi, Nora, Riboni, Laura, Marfia, Giovanni, Campanella, Rolando
• Format: Article
• Language: English
• Subjects: aPTT; Coagulation; D-dimer; Fibrinogen; GBM; VWF
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.09.177

Coagulation is an important aspect of the vascular microenvironment in which brain tumors evolve. Patients with tumor often show aberrant coagulation and fibrinolysis activation. In particular, glioblastoma (GBM), the most aggressive primary brain tumor, is associated with a state of hypercoagulability, and venous thromboembolism is a common complication of this cancer and its treatment. Our study aims to investigate the clinical and prognostic significance of routine laboratory tests to assess the coagulative state of patients with brain tumors, to identify potential new prognostic factors and targets for personalized therapy. Blood samples were collected from patients with GBM (n = 58) and patients with meningioma (MNG, n = 22), before any treatment. The parameters analyzed were prothrombin time (PT), activated partial thromboplastin time (aPTT), D dimer (DD), fibrinogen, von Willebrand factor (VWF), leukocyte count, and hemoglobin levels. Plasma levels of PT and aPTT were significantly reduced in GBMs compared with MNGs (P < 0.05), whereas DD, VWF:Ag levels, and leukocyte count were significantly higher in GBMs than in MNGs (P < 0.01). Furthermore, we observed that patients with GBM with reduced PT and aPTT and high levels of DD and VWF, defined as hypercoagulable patients, showed reduced overall survival (P < 0.05) compared with nonhypercoagulable patients. Our data support the assumption that patients with GBM show a plasma hypercoagulable profile and that coagulation profile is related to adverse outcome in patients with GBM. If confirmed, hypercoagulability could play an important role as a prognostic factor of the disease and in the decision of an antithrombotic prophylaxis. •Patients with GBM show an altered coagulation profile.•GBM patients show significantly shorter PT and aPTT values, and higher DD, VWF levels and leukocyte count than MNG ones.•Patients with GBM with a hypercoagulable status showed reduced overall survival.