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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Altered Baseline Fibrinolytic Activity in Lung Cancer Patients: A Functional Assessment using Plasma Lysis Time and Fibrinolytic Markers Anuha Vellanki1, Prakash Kempaiah1, Alexander Pohlman1, 2, Fakiha Siddiqui1, Walter Jeske 1, Debra Hoppensteadt1, Jeanine Walenga1, W.Keith Jones1, Jean Amiral1, Jawed Fareed1, Zaid Abdelsattar1. 1Loyola Univeristy Chicago, Maywood, IL, USA.2University of Illinois Chicago College of Medicine, Chicago, IL, USA |
Abstract
Background: Prolonged air leaks (PALs) are a clinical complication that can arise following lung resection surgery in patients with lung cancer. Fibrin deposition seals alveolar and pleural surfaces post-surgery, while fibrinolysis regulates the breakdown of fibrin upon completion. Hypofibrinolysis and hyperfibrinolysis are dysregulations in this process that can delay the sealing of air leaks and lead to impaired tissue sealing. In cases of hyperfibrinolysis, there may be a high level of the fibrinolytic activator tissue plasminogen activator (tPA), which causes excessive clot breakdown. Conversely, in hypofibrinolysis an elevated level of plasminogen activator inhibitor-1 (PAI-1) suppresses tPA activity which leads to impaired clot breakdown. Although, previous studies show the role of post-operative fibrinolysis times, data is lacking on the direct measurement of systemic fibrinolytic activity in lung cancer patients before and after surgery. Objectives: This study aims to evaluate pre- and post operative fibrinolytic activity in Lung Cancer patients undergoing lung resection surgery. Methods: In this prospective study, plasma samples were collected temporally from lung cancer patients (n=90). Each patient provided samples at pre-operation (Day 0) and one day post operatively (Day 1). Blood bank plasma (BBP) was used as a normal control (n=16). The plasma lysis time assay was performed using the Lysis Timer (Hyphen BioMed). We also measured levels of tPA and PAI-1 to correlate with lysis slope times. Data were analyzed to evaluate the relationship between plasma lysis slope duration time and fibrinolytic activity and expressed as a mean (SD). Results: Lung cancer patients demonstrated altered fibrinolytic activity in both pre-operative (Day 0) and early post-operative (Day 1) states, with mean lysis slope times of 36.49 ± 24.26 and 35.99 ± 21.41, respectively. Both were significantly lower compared to the control slope of 54.21 ± 27.39, indicating enhanced fibrinolysis in patients undergoing resection surgery (Figure 1). Consistent with these functional findings, tPA antigen levels were higher in lung cancer patients (Day 0: 7.81 ± 7.52 ng/mL; Day 1: 9.59 ± 7.55 ng/mL) compared to controls (6.60 ± 6.39 ng/mL) (Figure 2). PAI-1 levels were also elevated in Day 0 (32.40 ± 19.48 ng/mL) and Day 1 (30.09 ± 16.11 ng/mL) samples relative to controls (19.10 ± 12.41 ng/mL). These molecular changes align with hyperfibrinolytic activity in lung cancer patients both before and after surgery. Conclusion: Plasma lysis time revealed hyperfibrinolysis in lung cancer patients on both Day 0 and Day 1. Increased fibrinolysis is present even before surgery and persists into the early post-operative state. Fibrinolytic marker measurements corresponded with these findings, showing increased measurements in both the tPA and PAI-1 antigens compared to controls. Higher tPA levels being significantly increased between the control group and Day 1 group, leading to increased activation of clot breakdown in the post-operative group, potentially with impaired sealing and pulmonary air leakage (PAL). PAI-1 antigen levels being significantly increased in both pre- and post-operative states may suggest a compensatory anti-fibrinolytic response in correspondence to decreased lysis slope time in pre- and post-operative states as well.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.