Association of Fibrinolytic Potential and Risk of Mortality in Cancer Patients

SIMPLE SUMMARY: Cancer is a leading cause of death before age 70 and has significant impacts on public health. Cancer patients are at risk for blood clots, tumor progression, and death. The fibrinolytic system, which is involved in blood clotting, shows cooperative effects that facilitate the growth of tumors and the appearance of metastases. This prospective study evaluates the fibrinolytic potential in cancer patients and its association with mortality outcomes. Cancer patients were found to have a hypercoagulability profile and increased plasmin production compared to healthy individuals. Two thrombin generation parameters, maximum amplitude and area under the curve, showed an association with mortality risk. In conclusion, measuring thrombin concentration may help identify cancer patients with an elevated risk of death and further studies can play a crucial role in shedding light on the findings presented here. ABSTRACT: Cancer is a leading cause of death, and the fibrinolytic system shows cooperative effects that facilitate the growth of tumors and the appearance of metastases. This prospective study aimed to evaluate the fibrinolytic potential in cancer patients and its association with mortality outcomes using the fluorometric method of simultaneous thrombin and plasmin generation. The study included 323 cancer patients and 148 healthy individuals. During the 12-month follow-up, 68 patients died. Compared to the control group, cancer patients showed alterations in thrombin production consistent with a hypercoagulability profile, and an increase in plasmin generation. Mortality risk was associated with two parameters of thrombin in both univariate and multivariable analysis: maximum amplitude (Wald 11.78, p < 0.001) and area under the curve (Wald 8.0, p < 0.005), while such associations were not observed for plasmin. In conclusion, this was the first study able to demonstrate the simultaneous evaluation of thrombin and plasmin generation in newly diagnosed untreated cancer patients. Patients with cancer have been observed to exhibit a hypercoagulable profile. During the study, two parameters linked to thrombin generation, MA and AUC, were identified and found to have a potential association with mortality risk. However, no associations were found with parameters related to plasmin generation.