Abstract
Background: There is a high incidence of deep vein thrombosis (DVT) among cancer patients undergoing
chemotherapy. Chemotherapy-induced vascular endothelial cell activation (VECA) is characterized by increased
plasma levels of von Willebrand factor (vWF) and soluble P-selectin (sP-selectin), leading to the activation of
endothelial cells and signaling cascades. The biological role of a disintegrin-like and metalloproteinase with
thrombospondin type 1 motif, member 13 (ADAMTS-13) is to control the activity of vWF and consequently the risk
of thrombosis. The objective of this study was to investigate the roles of sP-selectin, vWF, and ADAMTS-13 as risk
factors for the first episode of DVT in cancer patients undergoing chemotherapy.
Methods: This prospective cohort study was conducted at Dr. Kariadi Hospital, Indonesia, on 40 cancer patients.
Prechemotherapy (baseline) and postchemotherapy sP-selectin, vWF antigen (vWF:Ag), and ADAMTS-13 plasma levels
were determined with ELISAs before and 3 months after chemotherapy. The clinical characteristics of the patients,
cancer type, cancer stage, chemotherapy regimen, ABO blood type, D-dimer level and Khorana risk score were also
analyzed using logistic regression. Patients were observed for the possibility of developing DVT during chemotherapy.
Results: DVT was confirmed in 5 patients (12.5%) after a period of 3 months. In patients with DVT, sP-selectin and vWF
were significantly higher while ADAMTS-13 was lower than in their counterparts. The levels of baseline vWF:Ag and
ADAMTS-13, with cut-off points ≥ 2.35 IU/mL and ≤ 1.03 IU/mL, respectively, were found to independently predict the
incidence of DVT. In the multivariate logistic regression analysis, the relative risk (RR) for DVT in patients with high vWF:
Ag was 3.80 (95% CI 1.15–12.48, p = 0.028), and that for patients with low ADAMTS-13 was 2.67 (95% CI 1.22–23.82, p =
0.005). The vWF:Ag/ADAMTS-13 ratio and both vWF:Ag and ADAMTS-13 dynamics during treatment were also able to
differentiate those with prospective DVT. However, sP-selectin and other covariates showed no statistical significance.
Conclusion: We found that prechemotherapy plasma levels of vWF:Ag ≥ 2.35 IU/mL and ADAMTS-13 ≤ 1.03 IU/mL are
independent risk factors for DVT incidence among cancer patients.

Keywords: Deep vein thrombosis, sP-selectin, vWF, ADAMTS-13, Cancer, Chemotherapy