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Abstract：
Introduction: A detailed evaluation of the malignancy-associated coagulopathy (MAC) in surgical patients with bone tumors may allow for more effective thromboprophylactic measures. The purpose of this study was to assess the perioperative hemostatic changes in patients with bone tumors, using rotational thromboelastometry (ROTEM). Methods: An observational study was performed, including 50 patients with bone tumors who underwent oncologic resection and 30 healthy controls, matched for age and gender. The preoperative and postoperative laboratory evaluation of coagulation in both groups included conventional coagulation tests and a ROTEM analysis. The results of the conventional coagulation tests and the ROTEM analysis were compared between the two groups. Results: The results of the conventional coagulation tests were comparable between the tumor patients and the healthy controls. However, compared to the healthy adults, the tumor patients had lower CT (p < 0.001) and CFT (p < 0.001) values suggesting a rapid induction of the coagulation cascade, elevated A10 (p < 0.001) and MCF (p < 0.001) values indicating a higher clot strength and platelet activation, and elevated LI60 (p < 0.001) values indicating hypofibrinolysis in patients with bone tumors. The multiple linear regression analysis (controlling for potential confounding factors) confirmed the independent association of bone tumors with these hemostatic changes. Conclusions: Our results support the advantageous use of a ROTEM in patients with bone tumors over conventional coagulation tests because the qualitative changes in the hemostatic profile of these patients that can be detected by a ROTEM analysis cannot be identified by conventional tests. The ROTEM results indicate that the hypercoagulable state in patients with bone tumors is caused by the malignancy-associated activation of the coagulation cascade, platelet activation, and hypofibrinolysis.
摘要：
背景：对骨肿瘤手术患者的恶性肿瘤相关性凝血病（MAC）的详细评估可能会提供更有效的血栓预防措施。这项研究的目的是评估骨肿瘤患者的围手术期止血变化，使用旋转血栓弹性测定法（ROTEM）。
方法：进行了一项观察性研究，包括50例接受肿瘤切除的骨肿瘤患者和30例健康对照，年龄和性别相匹配。两组术前和术后的凝血实验室评估包括常规凝血测试和ROTEM分析。比较两组常规凝血试验和ROTEM分析结果。
结果：肿瘤患者和健康对照组的常规凝血试验结果具有可比性。然而,与健康的成年人相比，肿瘤患者的CT(p<0.001)和CFT(p<0.001)值较低，提示凝血级联反应的快速诱导，升高的A10（p＆lt;0.001）和MCF（p＆lt;0.001）值表明更高的凝块强度和血小板活化，和升高的LI60（p＆lt;0.001）值表明骨肿瘤患者的纤维蛋白溶解不足。多元线性回归分析（控制潜在的混杂因素）证实了骨肿瘤与这些止血变化的独立关联。
结论：我们的结果支持在骨肿瘤患者中使用ROTEM优于常规凝血测试，因为通过ROTEM分析可以检测到的这些患者止血曲线的定性变化不能通过常规测试来识别。ROTEM结果表明，骨肿瘤患者的高凝状态是由恶性相关的凝血级联激活引起的，血小板活化,和纤维蛋白溶解不足。
方法：进行了一项观察性研究，包括50例接受肿瘤切除的骨肿瘤患者和30例健康对照，年龄和性别相匹配。两组术前和术后的凝血实验室评估包括常规凝血测试和ROTEM分析。比较两组常规凝血试验和ROTEM分析结果。
结果：肿瘤患者和健康对照组的常规凝血试验结果具有可比性。然而,与健康的成年人相比，肿瘤患者的CT(p<0.001)和CFT(p<0.001)值较低，提示凝血级联反应的快速诱导，升高的A10（p＆lt;0.001）和MCF（p＆lt;0.001）值表明更高的凝块强度和血小板活化，和升高的LI60（p＆lt;0.001）值表明骨肿瘤患者的纤维蛋白溶解不足。多元线性回归分析（控制潜在的混杂因素）证实了骨肿瘤与这些止血变化的独立关联。
结论：我们的结果支持在骨肿瘤患者中使用ROTEM优于常规凝血测试，因为通过ROTEM分析可以检测到的这些患者止血曲线的定性变化不能通过常规测试来识别。ROTEM结果表明，骨肿瘤患者的高凝状态是由恶性相关的凝血级联激活引起的，血小板活化,和纤维蛋白溶解不足。
