The Utility of Thromboelastography (TEG) Among Cancer Patients Undergoing Coronary Angiography

Background
Thromboelastography (TEG) may be performed in thrombocytopenic cancer patients undergoing coronary angiography (CA) to determine bleeding risk. We sought to determine the utility of TEG in predicting a hypocoagulable state, bleeding risk, and mortality among thrombocytopenic cancer patients with suspected coronary artery disease undergoing CA.

Methods
Cancer patients with chronic thrombocytopenia who underwent CA and concomitant TEG in a tertiary cancer center were retrospectively included. Baseline demographics, clinical data, and TEG parameters were recorded. Logistic regression was performed to determine the association between TEG parameters and primary endpoints: hypocoagulability (upon pathologist review), bleeding complications, and overall survival (OS).

Results
Seventy patients were included, of which 49 (70%) were men. Mean age was 67 and mean platelet count was 102.3 K/µL. No major bleeding complications occurred. Factors associated with improved OS at 24 months were daily aspirin (hazard ratio [HR]=0.475, p=0.025) or statin (HR=0.44, p=0.01) use. Nearly all TEG parameters were predictive of hypocoagulability. However, no TEG parameters were predictive of OS (Table 1).

Conclusions
Concern for bleeding should not deter physicians from performing CA in thrombocytopenic cancer patients when clinically indicated. Although TEG can predict a hypocoagulable state, it is not predictive of OS among thrombocytopenic cancer patients undergoing CA. Thus, its diagnostic utility is limited, and TEG should be performed judiciously among this unique population.