{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:50:07Z","timestamp":1791726607880,"version":"4.3.4"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Estrogen receptor (ER)\u2010positive (ER+) breast cancer accounts for approximately 75% of all breast cancers. Tamoxifen, a selective estrogen receptor modulator, is the standard adjuvant treatment. Although better tolerated than aromatase inhibitors, tamoxifen increases the risk of venous thromboembolism (VTE) 1.4\u2010fold.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the hemostatic imbalance induced by tamoxifen in adjuvant treatment of ER+ breast cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Twenty\u2010five patients in remission from ER+ breast cancer under tamoxifen were included. One hundred and thirty one age\u2010 and BMI\u2010matched healthy controls were included to establish reference ranges of thrombin generation assay (TGA) parameters. TGA was performed in the absence and presence of exogenous activated protein C (APC) to calculate the normalized APC sensitivity ratio (nAPCsr), a marker of APC resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All TG parameters except the endogenous thrombin potential (ETP) (\u2212APC) were significantly impacted by tamoxifen (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In absence of APC, regardless of TGA parameters, at least 50% of results were outside the reference ranges except for ETP, which was above the upper reference limit in only two individuals. The most impacted parameter was the Peak Height with 52% (\u2212APC) and 80% (+APC) of results above the upper reference range limit, respectively. The nAPCsr was significantly higher in tamoxifen users (mean\u2009\u00b1\u2009standard deviation\u2009=\u20093.18\u2009\u00b1\u20090.91) compared to the control group (2.19\u2009\u00b1\u20090.92, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This observational study showed that patients in remission from ER+ breast cancer taking tamoxifen had altered thrombin generation, as well as an acquired APC resistance. Moreover, this is the first study using the validated ETP\u2010based APC resistance assay in tamoxifen\u2010treated patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijlh.14242","type":"journal-article","created":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T02:54:47Z","timestamp":1706756087000},"page":"546-554","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Hemostatic imbalance induced by tamoxifen in estrogen receptor\u2010positive breast cancer patients: An observational study"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9170-0314","authenticated-orcid":false,"given":"Marie","family":"Didembourg","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS) University of Namur  Namur Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Reda","sequence":"additional","affiliation":[{"name":"Institute of Experimental Hematology and Transfusion Medicine University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Oldenburg","sequence":"additional","affiliation":[{"name":"Institute of Experimental Hematology and Transfusion Medicine University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiko","family":"R\u00fchl","sequence":"additional","affiliation":[{"name":"Institute of Experimental Hematology and Transfusion Medicine University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7644-5298","authenticated-orcid":false,"given":"Jonathan","family":"Douxfils","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS) University of Namur  Namur Belgium"},{"name":"Research and Development Department QUALI blood s.a.  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