P125 | CLINICAL OF USE OF THROMBIN GENERATION AND D-DIMER TO PERSONALIZE LONG TERM ANTITHROMBOTIC TREATMENT IN CANCER PATIENTS.

Venous thromboembolism (VTE) is a frequent complication in cancer patients. While there is conclusive evidence on treatment during the acute phase, data on secondary prophylaxis remain limited. The factors influencing the initiation and duration of secondary prophylaxis include patient characteristics and oncologic factors. The Thrombin Generation Test (TGT) is a test that evaluates thrombin generation and decay, providing a balanced view of coagulation. The purpose of this study is to better characterize the hypercoagulability status of cancer patients using the Thrombin Generation Analyzer (ST Genesia®, Stago Diagnostics, Asnières, France) and to understand its utility in guiding secondary prophylaxis decisions. A total of 39 cancer patients on secondary prophylaxis for VTE were enrolled, and their thrombin generation time was determined. Antithrombotic therapy was suspended before blood sampling, and the absence of anticoagulants was confirmed via assays. The median age of the patients was 66 years; 46% had gynecological tumors, 23% gastrointestinal, 20% lung, and 11% other sites. Elevated D-dimer levels were observed in 72% of patients. Disease status varied, with 38% in complete remission, 51% showing stable or partial response, and 10% in progression. Additionally, 77% had complete recanalization of their thrombosis; 10% of the patients were on prophylaxis with low molecular weight heparins, while 90% received a direct oral anticoagulant (DOAC) at prophylactic dosage. TGT results revealed that 36% of patients had a hypercoagulable state, 28% had hypocoagulability, and 36% had normal thrombin generation. The recurrence rate of thrombosis was 10%. Our findings, although based on a limited patient cohort, demonstrate that oncologic patients exhibit a heterogeneous coagulative profile that cannot be adequately described by D-dimer levels alone. Only 36% of the patients exhibited a hypercoagulable state as determined by TGT. Despite this variability, these patients remain at high thrombotic risk, as supported by existing literature. Given this complexity and variability in coagulative profiles, there is currently no evidence to support the use of TGT as laboratory criterion for guiding secondary antithrombotic prophylaxis in this patient population. Further studies are necessary to better understand the coagulative dynamics in oncologic patients and more efective strategies to optimize long-term antithrombotic strategies.