Table 1 Summary of haemostatic parameters measured in patients with ALL pre-treatment (d0) at d29 and over 36 days of induction chemotherapy

From: Evaluation of coagulopathy before and during induction chemotherapy for acute lymphoblastic leukaemia, including assessment of global clotting tests

Parameter

Normal controls n=20

ALL study patients (n=35) d0 results compared to normal reference range

ALL study patients d0 vs normal controls

ALL study patients (n=26) d29 results compared to normal reference range

ALL study patients (n=26) d29 vs d0

VTE vs no VTE at d0

VTE vs no VTE over 36 days

 
 

Mean±s.e.m.

Mean±s.e.m. in ALL

Below range

Above range

P-value

Mean±s.e.m. in ALL

Below range

Above range

P-value

P-value

P-value

PLT (× 109/l)

258.7±14.5

106.0±25.88

80% (n=28)

9% (n=3)

Lower in ALL P<0.0001

252.6±24.9

19% (n=5)

12% (n=3)

Higher at d29 P<0.0001

Higher in VTE P<0.05

Higher in VTE P<0.001

PT (s)

10.2±0.1

10.97±0.24

3% (n=1)

14% (n=5)

Longer in ALL P<0.05

12.22±0.30

0%

42% (n=11)

Higher at d29 P=0.0027

NS

NS

PTT (s)

25.4±0.3

24.36±0.64

49% (n=17)

3% (n=1)

NS

37.5±5.20

8% (n=2)

42% (n=11)

Higher at d29 P=0.0049

NS

NS

Clauss fibrinogen (g/l)

2.7±0.2

2.98±0.26

14% (n=5)

29% (n=10)

NS

1.02±0.09

85% (n=22)

0%

Lower at d29 P<0.0001

Higher in VTE P<0.001

NS

D dimer (ng/ml)

<500

4072±572.4

0%

97% (n=34)

Higher in ALL P<0.0001

Not tested

  

Not tested

NS

Not done

VWF:Ag (μ/ml)

1.01±0.09

1.84±0.11

0%

37% (n=13)

Higher in ALL P<0.0001

2.22±0.21

0%

42% (n=11)

NS

Higher in VTE P<0.01

Higher in VTE P<0.05

Factor VIII (μ/ml)

1.07±0.06

2.18±0.14

0%

77% (n=27)

Higher in ALL P<0.0001

2.00±0.13

0%

73% (n=19)

NS

NS

NS

Antithrombin (μ/ml)

1.01±0.02

1.08±0.03

9% (n=3)

11% (n=4)

NS

0.70±0.04

69% (n=18)

0%

Lower at d29 <0.0001

NS

NS

Protein C (μ/ml)

1.08±0.04

1.15±0.07

9% (n=3)

23% (n=8)

NS

0.96±0.07

19% (n=5)

0%

NS

NS

NS

Free protein S (μ/ml)

1.03±0.05

0.85±0.04

6% (n=2)

0% (n=0)

Lower in ALL P<0.01

0.66±0.05

19% (n=5)

0%

Lower at d29 P=0.0197

NS

NS

ETP (nm/min)

1585±56.2

1148±73.31

66% (n=23)

11% (n=4)

Lower in ALL P<0.001

1306±132.8

42% (n=11)

15% (n=4)

NS

NS

Higher in VTE P<0.001

Peak (nm)

273.7±19.6

193.3±16.48

57% (n=20)

9% (n=3)

Lower in ALL P<0.01

159±25.23

69% (n=18)

8% (n=2)

NS

NS

Higher in VTE P<0.001

EXTEM MCF (mm)

63.9±1.1

53.71±3.04

40% (n=14)

14% (n=5)

Lower in ALL P<0.05

50.82±2.95

35% (n=9)

0%

NS

NS

Higher in VTE P<0.05

EXTEM CT (s)

74.0±2.4

96.69±15.41

3% (n=1)

23% (n=8)

NS

87.09±7.78

4% (n=1)

35% (n=9)

NS

NS

Shorter in VTE P<0.001

FIBTEM MCF (mm)

14.8±0.8

22.38±1.78

3% (n=1)

34% (n=12)

Higher in ALL P<0.01

13.95±1.75

27% (n=7)

12% (n=3)

Lower at d29 P=0.0036

Higher in VTE P<0.05

NS

INTEM CT (s)

185.3±4.2

176.5±11.36

0%

9% (n=3)

NS

192.4±14.94

4% (n=1)

12% (n=3)

NS

NS

Shorter in VTE P<0.05

  1. Abbreviations: ALL, acute lymphoblastic leukaemia; ETP, endogenous thrombin potential (area under curve); EXTEM CT, clotting time initiated by extrinsic pathway using ROTEM; EXTEM MCF, maximal clot firmness initiated by extrinsic pathway using ROTEM; INTEM CT, clotting time initiated by intrinsic pathway using ROTEM; INTEM MCF, maximal clot firmness intrinsic pathway using ROTEM; NS, non-significant (P>0.05); Peak, peak thrombin generation; PT, prothrombin time; PTT, partial thromboplastin time; VTE, venous thromboembolism; VWF:Ag, Von Willibrand Factor antigen. Test results were classified as ‘below range’ or above range’ according to whether the results were outside 95% institutional reference intervals that were age and gender specific as appropriate. Pre-treatment data are expressed as mean±s.e.m. Pre-treatment comparison of results in patients who later went on to develop VTE (n=6) with those who didn’t (n=29). D29 results and comparison of d29 vs d0 results only included those patients who received Peg-Asparaginase and had a sample available for both time points (n=26). P-values generated using one-way ANOVA with Dunnett’s post hoc test. Comparison of results between ALL patients with and without VTE over 36 days: P-values generated using repeated measures ANOVA for normally distributed data and Kruskal–Wallis test for non-parametric data (to assess for difference between VTE and non-VTE groups).
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