Abstract
The incidence of venous thrombosis in patients undergoing chemotherapy is high. Activation of vascular endothelium during chemotherapy is followed by elevated concentrations of von Willebrand factor (vWF), decreased concentrations of ADAMTS13, and increased thrombotic risk. Objective. To study the significance of vWF:Ag and ADAMTS13:Ag concentrations and the ratio of vWF:Ag to ADAMTS13:Ag (VWF:Ag/ADAMTS13:Ag) as risk factors for thrombosis in gynecologic cancer patients undergoing chemotherapy. Patients and methods. The prospective controlled interventional non-randomized trial included 222 patients aged 34 to 72 years who underwent elective surgical treatment (138 patients) and chemotherapy courses (84 patients), and 50 healthy women in the control group. Concentrations of vWF:Ag and ADAMTS13:Ag, as well as markers of hemostatic activation such as thrombin-antithrombin complex (TAT) and D-dimer were determined in the patients’ plasma before therapy (baseline levels), 14 days after surgical treatment, and 14 days after 2 courses of chemotherapy. Results. Concentrations of vWF:Ag were significantly higher and concentrations of ADAMTS13:Ag were significantly lower among cancer patients both before and after surgical treatment and after chemotherapy compared to healthy controls. There was a significant difference in the dynamics of indicators in patients after chemotherapy compared to patients after surgical treatment. Significant changes in the vWF:Ag/ADAMTS13:Ag ratio between the groups of patients after surgical treatment and on the background of chemotherapy were also confirmed. A correlation was found between an increase in vWF:Ag concentrations, vWF:Ag/ADAMTS13:Ag ratio and TAT concentrations, and thus the risk of thrombosis. The study was conducted against the background of using standard thromboprophylaxis regimens in all patients, considering the high risk of thrombosis in all patients included in the study, according to standard thrombosis risk assessment scales. Conclusion. Concentrations of vWF:Ag, ADAMTS13:Ag and the vWF:Ag/ADAMTS13:Ag ratio can be considered as predictors of thrombosis during chemotherapy in gynecologic cancer patients. Key words: von Willebrand factor, ADAMTS13, cancer, chemotherapy
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