The drug of choice for the initial treatment of "decoppering" in Wilson's disease, an inherited disorder of copper metabolism, is the chelating agent D-penicillamine. In the case of harmful side-effects an alternative drug is triethylenetetramine dihydrochloride (trien or trientine). Using the 24-h-urine excretion of copper and the oral copper loading test with copper-64, a double function for trien was found: trien increases the urine copper excretion and decreases the intestinal copper absorption respectively.
<b><i>Background:</i></b> Venous thromboembolism (VTE) is a common complication of cancer. This study aimed to evaluate immature platelet fraction (IPF), mean platelet volume (MPV), P-selectin, D-dimer, and thrombin generation (TG) as predictive biomarkers for VTE and further the improvement of existing risk assessment models (RAMs). <b><i>Methods:</i></b> A prospective, observational, exploratory study was conducted on ambulatory cancer patients with indication for systemic chemotherapy. Baseline RAMs included the Khorana-, Vienna Cancer, Thrombosis-, Protecht-, ONKOTEV-, and Catscore. IPF, MPV, P-selectin, D-dimer, and TG were analysed at baseline and 3-month follow-up. <b><i>Results:</i></b> We enrolled 100 patients, of whom 89 completed the follow-up. Frequent tumour types were breast (30%), gastric (14%), gynaecological (14%), and colorectal (14%) cancer. Ten of the 89 patients (11.2%) developed VTE. The highest VTE rate was observed in patients with cholangiocarcinoma (3/5; 60%). Baseline D-dimer levels but not IPF, MPV, or P-selectin were associated with the risk of developing VTE (HR 6.9; <i>p</i> = 0.021). None of the RAMs showed statistical significance in predicting VTE. Peak thrombin and endogenous thrombin potential were lower in patients who developed VTE. Biomarker changes between baseline and follow-up were not associated with VTE risk. <b><i>Conclusions:</i></b> VTE risk was well predicted by baseline D-dimer levels. Adding D-dimer could improve existing RAMs to better identify patients who may benefit from primary VTE prophylaxis. The VTE risk among patients with cholangiocarcinoma should be further evaluated.
Hintergrund: Es ist bekannt, dass Tumorpatienten im Vergleich zur Normalbevölkerung gehäuft thrombembolische Ereignisse erleiden. 15 bis 20% der Patienten mit venöser Thrombembolie (VTE) leiden an einem malignen Tumor. Die Generierung von Thrombin ist ein zentrales Moment in der Genese eines stabilen "thrombinclots" und somit in der Entstehung einer VTE. Die Thrombingenerierung bzw. das endogene Thrombinpotential (ETP) ist als time to peak (Zeit bis zur maximalen Reaktionsgeschwindigkeit der Thrombinbildung) und als lag time (Zeit bis zum Anstieg der Reaktionsgeschwindigkeit) messbar. Ziel dieser Studie war es, die Thrombingenerierung von Patienten mit Lungenkarzinom mit der von gesunden Probanden zu vergleichen.
