Analysis and Research on Gastrointestinal Bleeding and Coagulation Indicators in Tumor Patients

Analysis and Research on Gastrointestinal Bleeding and Coagulation Indicators in Tumor Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis and Research on Gastrointestinal Bleeding and Coagulation Indicators in Tumor Patients Shaoqing Ai, Jun Gao, Jie Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9356549/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To investigate the correlation between gastrointestinal bleeding in tumor patients and various coagulation parameters. Methods: A retrospective analysis was conducted on 211 hospitalized tumor patients with gastrointestinal bleeding treated at multiple departments of our hospital over the past five years. The analysis revealed significant differences in the distribution characteristics of the coagulation parameters. The percentage activity of prothrombin showed wide fluctuations, while fibrinogen levels were relatively concentrated. The international normalized ratio (INR) was strongly positively correlated with prothrombin time (PT), and the percentage activity of prothrombin was strongly negatively correlated with both INR and PT. Fibrinogen exhibited relatively weak correlations with other parameters. Results: The combined assessment of INR and PT is expected to improve the predictive accuracy for gastrointestinal bleeding risk in tumor patients. Monitoring changes in prothrombin activity percentage, in conjunction with INR and PT, may enable more timely detection of coagulation abnormalities, facilitating early clinical intervention and reducing bleeding risk. Conclusion: INR is strongly positively correlated with PT, and prothrombin activity percentage is strongly negatively correlated with both. These findings are of great significance for predicting bleeding risk and guiding clinical management and future research. Digestive system neoplasms Gastrointestinal hemorrhage Gastrointestinal hemorrhage Risk assessment Figures Figure 1 Introduction In recent years, the incidence and mortality rates of gastrointestinal tumors have been increasing annually, often accompanied by coagulation disorders. Among them, gastrointestinal bleeding is a serious complication, which seriously affects the prognosis and quality of life of patients 【 1 】 . Understanding the relationship between gastrointestinal bleeding in tumor patients and coagulation indexes has important clinical value for early diagnosis, treatment, and prevention 【 2 】 . In recent years, with the continuous development of medical technology, the research on coagulation indexes has gradually deepened. Although research on coagulation parameters has progressively deepened with advances in medical technology, a comprehensive analysis of coagulation parameters specifically related to gastrointestinal bleeding in tumor patients remains an area requiring further investigation 【 3 】 . 1. Materials and Methods 1. 1 Study Population Data for this retrospective study were obtained from inpatients at the Second Affiliated Hospital of Xi'an Medical University, specifically from the Departments of Oncology and Gastroenterology. A total of 211 patients diagnosed with gastrointestinal tumors between January 1, 2020 to December 31, 2024 were included. These patients met the clinical diagnostic criteria for gastrointestinal tumors, had not received any clinical treatments recently (including surgery, chemotherapy, radiotherapy, and biotherapy, etc.), and had coagulation indexes when accompanied by gastrointestinal bleeding (relevant information such as international normalized ratio, thrombin time, prothrombin percentage activity, prothrombin time, fibrinogen, activated partial thromboplastin time, etc.) The patient demographics include 167 males and 44 females, aged between 31 and 93 years. Tumor types consist of 17 cases (8.06%) of esophageal cancer, 191 cases (90.52%) of gastric cancer, and 3 cases (1.42%) of colorectal cancer. Histological classifications include 17 squamous cell carcinomas and 194 adenocarcinomas. Clinical stages are distributed as 124 cases (58.77%) in Stage III and 87 cases (41.23%) in Stage IV. Detailed data are presented in （ Table 1.1 ） Table 1 .1 Demographic and Clinical Characteristics of Patients with Digestive System Tumors (N=211) Items Clinical Parameters Number of Cases Proportion (%) Tumor Category Esophageal Cancer Gastric Cancer Colorectal Cancer 17 191 3 8.06 90.52 1.42 Gender Male Female 167 44 79.15 20.85 Age Group (years old) < 60 ≥ 60 57 154 27.01 72.99 Pathological type Squamous Cell Carcinoma Adenocarcinoma 17 194 8.06 91.94 Tumor stage Ⅲ Ⅳ 124 87 58.77 41.23 1.2 Statistical Analysis s Data were collected from January 1, 2020, to December 31, 2024. Patient information was anonymized during and after data collection to ensure confidentiality.Statistical analyses were performed using SPSS version 26.0 software. Descriptive statistics, including mean, median, standard deviation, minimum, and maximum, were calculated for each coagulation parameter to understand their distribution. Correlations among coagulation parameters were explored by calculating a correlation coefficient matrix. Line charts were generated for each parameter according to the sample order to visualize their trends across the patient cohort. 2. Results Table2- 1 Descriptive Statistics of Coagulation Parameters Index Count Mean Standard Deviation Minimum Q1 Median Q3 Maximum INR(0.8-1.5) 211.00 1.27 0.76 0.67 0.99 1.18 1.34 8.29 TT(11-17.8) 211.00 17.63 5.51 11.40 14.85 16.70 18.50 65.00 PT%(88-149) 211.00 85.17 30.43 10.00 67.00 78.00 101.00 199.00 PT(9.6-15.1) 211.00 16.38 7.64 9.60 13.40 15.40 17.60 86.20 FIB(2.2-4.96) 211.00 3.05 1.14 0.48 2.26 3.00 3.86 6.20 APTT(27.1-38.4) 211.00 27.57 4.66 17.30 24.05 27.40 30.50 42.70 SD: standard deviation; Q1: first quartile; Q3: third quartile; INR: international normalized ratio; TT: thrombin time; PT%: prothrombin activity percentage; PT: prothrombin time; FIB: fibrinogen; APTT: activated partial thromboplastin time . Descriptive statistics for the six coagulation parameters ( Table2- 1 ）revealed substantial differences in their mean values, variability, and ranges. Notably, PT% exhibited considerable fluctuation (mean 85.17%, SD 30.43), whereas FIB levels were relatively more concentrated (mean 3.05 g/L, SD 1.14). These differences likely reflect the distinct physiological baselines and varying susceptibility to pathological influences of each parameter Table2- 2 Correlation Matrix of Coagulation Parameters INR TT PT% PT FIB APTT INR 1.00 0.20 -0.55 0.99 -0.15 0.48 TT 0.20 1.00 -0.34 0.21 -0.57 0.23 PT% -0.55 -0.34 1.00 -0.58 0.38 -0.52 PT 0.99 0.21 -0.58 1.00 -0.18 0.48 FIB -0.15 -0.57 0.38 -0.18 1.00 -0.14 APTT 0.48 0.23 -0.52 0.48 -0.14 1.00 The correlation matrix ( Table2- 2 ）demonstrated an extremely strong positive correlation between INR and PT (r = 0.99), suggesting they may be co-regulated by similar physiological mechanisms or clinical factors. Conversely, PT% showed strong negative correlations with both INR (r = -0.55) and PT (r = -0.58), indicating a potential antagonistic relationship during coagulation. Fibrinogen exhibited relatively weak correlations with most other parameters, except for a moderate negative correlation with TT (r = -0.57), suggesting it may be influenced by independent pathways. Table 2- 3 Trends of Coagulation Parameters Across the Patient Cohort Table2- 3 Line charts illustrating the trends of six coagulation parameters (INR, TT, PT%, PT, FIB, APTT) plotted against the order of 211 patients. This visualization highlights inter-individual variability and co-trending patterns.The line charts (Figure 2.1) visually confirmed the descriptive statistics and correlation analyses. PT% displayed the most pronounced fluctuations, suggesting significant inter-individual variability potentially related to disease stage or external factors. The trends for INR and PT were closely aligned, consistent with their strong positive correlation. In contrast, the trend for FIB was distinct from most other parameters, reinforcing its relatively independent behavior. 3. Discussion 【 Principal Findings 】 This study identified significant correlations among coagulation parameters in tumor patients with gastrointestinal bleeding, notably the strong positive correlation between INR and PT, and the strong negative correlations of PT% with both INR and PT. FIB appeared to behave more independently. These findings offer insights into the complex coagulopathy associated with malignancy. 【 Relationship with Pathophysiology 】 The observed distribution and correlation patterns may be closely linked to the pathophysiological state of tumor patients. Malignant cells can activate the extrinsic coagulation pathway by releasing tissue factor and cancer procoagulants, thereby influencing INR and PT 【 4 】 . The near-perfect correlation between INR and PT (r=0.99) suggests that in this patient population, the drivers of change for these two parameters are highly congruent. The strong negative correlation of PT% with INR and PT may reflect a compensatory or regulatory mechanism, where the consumption or inhibition of prothrombin (reflected by decreased PT%) occurs in response to its excessive activation (reflected by prolonged PT and elevated INR) 【 5 】 . The relative independence of FIB suggests its regulation might be more strongly influenced by the systemic inflammatory response, a common paraneoplastic phenomenon, rather than by the same pathways that govern the PT/INR axis. 【 Clinical Significance and Implications 】 These findings have practical implications for clinical management. The combined assessment of strongly correlated parameters, such as INR and PT, could enhance the accuracy of bleeding risk prediction compared to evaluating a single parameter in isolation 【 6, 】 【 7 】 . Simultaneous elevation of INR and PT may signal a significant coagulation derangement warranting heightened vigilance and potential prophylactic intervention, even in the absence of overt bleeding. Furthermore, monitoring PT% alongside INR and PT could provide a more dynamic picture of coagulation status, as a declining PT% might foreshadow an increased bleeding risk before substantial changes in INR or PT occur. This integrated approach could guide more precise and timely adjustments to treatment plans, ultimately aiming to reduce the incidence of gastrointestinal bleeding. Patient education on recognizing bleeding signs and avoiding risk factors remains a crucial component of comprehensive care 【 8 】 - 【 10 】 . 【 Limitations 】 This study has several limitations. First, its retrospective, single-center design may introduce selection bias. Second, the sample size (n=211), while reasonable, may not be sufficiently large to conduct robust subgroup analyses based on specific tumor type, stage, or histological grade, which are known to influence coagulation 【 11 】 . Third, we lacked data on potential confounders such as detailed treatment history (beyond the exclusion of recent therapy), comorbidities (e.g., liver disease, infection), and medications (e.g., anticoagulants, antiplatelet agents) that could significantly impact coagulation parameters. The absence of this information limits our ability to fully delineate the independent effects of the tumor itself. 【 Future Research Directions 】 Future research should address these limitations. Prospective, multi-center studies with larger, more diverse cohorts are needed to validate our findings. Stratified analyses by tumor type, stage, and histological subtype would help clarify the specific impact of different malignancies on coagulation 【 12 】 . Comprehensive data collection should include detailed information on treatments, comorbidities, medications, and markers of inflammation to allow for multi-variable analysis and control of confounding. Long-term follow-up studies are essential to determine the prognostic value of baseline and dynamic changes in these coagulation parameters for predicting not only bleeding risk but also thrombotic events and overall survival 【 13- 】 】 15 】 . Finally, integrating molecular biomarkers could help elucidate the underlying mechanisms linking tumor biology to coagulation dysregulation. Conclusion In conclusion, this study demonstrates a strong positive correlation between INR and PT and a strong negative correlation of PT% with both parameters in tumor patients with gastrointestinal bleeding. These findings underscore the interconnected nature of coagulation abnormalities in this context and suggest that a multi-parameter assessment, rather than reliance on any single index, may offer a more comprehensive and clinically useful evaluation of bleeding risk. While further research is warranted to confirm these findings and explore underlying mechanisms, our study provides a valuable foundation for integrating coagulation parameter correlations into risk stratification and clinical decision-making for tumor patients at risk of gastrointestinal bleeding. Declarations Ethical Approval and Compliance This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by [Medical Ethics Committee of the Second Affiliated Hospital of Xi'an Medical University ] (Approval No.: [2020LP03], Date: [2020.6.10]). The study was conducted in accordance with the ethical guidelines and regulations of the above‑mentioned ethics committee. Ethical Approval and accordance Informed consent was obtained from all the individual participants for participation in this study. Ethical Approval and accordance Informed consent was obtained from all the individual participants for publication. References Bai S ,Sun Y ,Xu H .Impact of Gastrointestinal Bleeding on Prognosis and Associated Risk Factors in Gastrointestinal Stromal Tumors: A Systematic Review and Meta-Analysis.[J].The American surgeon,2024,31348241307402. Basahai I ,Alzeer A M ,Almuhanna S B .Successful treatment of gastric bleeding caused by left phrenic artery pseudoaneurysm post-surgery with endovascular embolization: A case report.[J].Radiology case reports,2024,19(6):2351-2356. Patil G ,Kanetkar R S .Study of Coagulation Parameters in Gastrointestinal Malignancies.[J].Cureus,2024,16(10):e72162. 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Peng Q ,Zhu J ,Ren X .Thromboelastogram and coagulation function index: relevance for female breast cancer[J].Frontiers in Oncology,2024,141342439-1342439. Peng Q ,Zhu J ,Zhang Y , et al.Blood hypercoagulability and thrombosis mechanisms in cancer patients -A brief review[J].Heliyon,2024,10(19):e38831-e38831. Sugawara N ,Iwatsubo T ,Mori Y , et al.Novel gel-immersion endoscopic injection sclerotherapy method for prophylactic hemostasis of esophageal varices: A pilot feasibility and safety study (with video).[J].DEN open,2025,5(1):e70056. Choi J S ,Koo K Y ,Kim S , et al.Association of time to red blood cell transfusion on outcomes in patients with gastrointestinal bleeding.[J].Annals of medicine,2025,57(1):2474858. Smeda M ,Maleki H E ,Jasztal A .A possible role of plasmin-dependent activation of TGF-β in cancer-associated thrombosis: Implications for therapy[J].Cancer and Metastasis Reviews,2024,44(1):2-2. Zhang Y ,Sun Z ,Wang Z , et al.Associations Between Inflammatory Indexes, Coagulation Indexes, and Fuhrman Grade of Clear Cell Renal Cell Carcinoma.[J].Annals of surgical oncology,2024,31(7):4185-4188. Singh R S ,Kanamadi R G ,Thokchom B , et al.A study on the antioxidant, cytotoxicity, and coagulation potential of carbon quantum dots derived from the leaves of Lagerstroemia speciosa[J].Hybrid Advances,2025,10100430-100430. Kudo R ,Matsumoto K ,Ishiguro T , et al.Appendiceal cancer in pregnancy and circulating tumor cells detection in the umbilical cord[J].Heliyon,2025,11(3):e42411-e42411. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Among them, gastrointestinal bleeding is a serious complication, which seriously affects the prognosis and quality of life of patients\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e1\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e. Understanding the relationship between gastrointestinal bleeding in tumor patients and coagulation indexes has important clinical value for early diagnosis, treatment, and prevention\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e. In recent years, with the continuous development of medical technology, the research on coagulation indexes has gradually deepened. Although research on coagulation parameters has progressively deepened with advances in medical technology, a comprehensive analysis of coagulation parameters specifically related to gastrointestinal bleeding in tumor patients remains an area requiring further investigation\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e.\u003c/p\u003e"},{"header":"1. Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e1. 1 Study Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData for this retrospective study were obtained from inpatients at the Second Affiliated Hospital of Xi\u0026apos;an Medical University, specifically from the Departments of Oncology and Gastroenterology. \u0026nbsp;A total of 211 patients diagnosed with gastrointestinal tumors between January 1, 2020 to December 31, 2024 were included. These patients met the clinical diagnostic criteria for gastrointestinal tumors, had not received any clinical treatments recently (including surgery, chemotherapy, radiotherapy, and biotherapy, etc.), and had coagulation indexes when accompanied by gastrointestinal bleeding (relevant information such as international normalized ratio, thrombin time, prothrombin percentage activity, prothrombin time, fibrinogen, activated partial thromboplastin time, etc.)\u003c/p\u003e\n\u003cp\u003eThe patient demographics include 167 males and 44 females, aged between 31 and 93 years. Tumor types consist of 17 cases (8.06%) of esophageal cancer, 191 cases (90.52%) of gastric cancer, and 3 cases (1.42%) of colorectal cancer. Histological classifications include 17 squamous cell carcinomas and 194 adenocarcinomas. Clinical stages are distributed as 124 cases (58.77%) in Stage III and 87 cases (41.23%) in Stage IV. Detailed data are presented in\u0026nbsp;（\u003cstrong\u003eTable 1.1\u003c/strong\u003e）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e.1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDemographic and Clinical Characteristics of Patients with Digestive System Tumors (N=211)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProportion (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.0441%;\"\u003e\n \u003cp\u003eTumor Category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.6314%;\"\u003e\n \u003cp\u003eEsophageal Cancer\u003cbr\u003e\u0026nbsp;Gastric Cancer\u003cbr\u003e\u0026nbsp;Colorectal Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e8.06\u003c/p\u003e\n \u003cp\u003e90.52\u003c/p\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.0441%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.6314%;\"\u003e\n \u003cp\u003eMale\u003cbr\u003e\u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e79.15\u003c/p\u003e\n \u003cp\u003e20.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.0441%;\"\u003e\n \u003cp\u003eAge Group (years old)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.6314%;\"\u003e\n \u003cp\u003e\u0026lt; 60\u003cbr\u003e\u0026nbsp;\u0026ge; 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e27.01\u003c/p\u003e\n \u003cp\u003e72.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.0441%;\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.6314%;\"\u003e\n \u003cp\u003eSquamous Cell Carcinoma\u003c/p\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e17\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e8.06\u003c/p\u003e\n \u003cp\u003e91.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.0441%;\"\u003e\n \u003cp\u003eTumor stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.6314%;\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e58.77\u003c/p\u003e\n \u003cp\u003e41.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e1.2 \u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected from January 1, 2020, to December 31, 2024. Patient information was anonymized during and after data collection to ensure confidentiality.Statistical analyses were performed using SPSS version 26.0 software. Descriptive statistics, including mean, median, standard deviation, minimum, and maximum, were calculated for each coagulation parameter to understand their distribution. Correlations among coagulation parameters were explored by calculating a correlation coefficient matrix. Line charts were generated for each parameter according to the sample order to visualize their trends across the patient cohort.\u003c/p\u003e"},{"header":"2. Results","content":"\u003cp\u003e\u003cstrong\u003eTable2-\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Descriptive Statistics of Coagulation Parameters\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCount\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinimum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQ1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Q3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eINR(0.8-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e211.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e8.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eTT(11-17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e211.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e17.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e11.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e14.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e16.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e18.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e65.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePT%(88-149)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e211.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e85.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e30.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e10.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e67.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e78.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e101.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e199.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePT(9.6-15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e211.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e16.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e7.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e9.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e13.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e15.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e17.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e86.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eFIB(2.2-4.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e211.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e6.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eAPTT(27.1-38.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e211.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e27.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e17.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e24.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e27.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e30.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e42.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSD: standard deviation; Q1: first quartile; Q3: third quartile; INR: international normalized ratio; TT: thrombin time; PT%: prothrombin activity percentage; PT: prothrombin time; FIB: fibrinogen; APTT: activated partial thromboplastin time\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eDescriptive statistics for the six coagulation parameters (\u003cstrong\u003eTable2- 1\u003c/strong\u003e）revealed substantial differences in their mean values, variability, and ranges. Notably, PT% exhibited considerable fluctuation (mean 85.17%, SD 30.43), whereas FIB levels were relatively more concentrated (mean 3.05 g/L, SD 1.14). These differences likely reflect the distinct physiological baselines and varying susceptibility to pathological influences of each parameter\u003c/p\u003e\n\u003ch3\u003eTable2-\u0026nbsp;2\u0026nbsp;Correlation Matrix of Coagulation Parameters\u003c/h3\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eINR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePT%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPTT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eINR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePT%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPTT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe correlation matrix (\u003cstrong\u003eTable2- 2\u003c/strong\u003e）demonstrated an extremely strong positive correlation between INR and PT (r = 0.99), suggesting they may be co-regulated by similar physiological mechanisms or clinical factors. Conversely, PT% showed strong negative correlations with both INR (r = -0.55) and PT (r = -0.58), indicating a potential antagonistic relationship during coagulation. Fibrinogen exhibited relatively weak correlations with most other parameters, except for a moderate negative correlation with TT (r = -0.57), suggesting it may be influenced by independent pathways.\u003c/p\u003e\n\u003ch3\u003eTable 2- 3 Trends of Coagulation Parameters Across the Patient Cohort\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eTable2- 3\u003c/strong\u003e Line charts illustrating the trends of six coagulation parameters (INR, TT, PT%, PT, FIB, APTT) plotted against the order of 211 patients. This visualization highlights inter-individual variability and co-trending patterns.The line charts (Figure 2.1) visually confirmed the descriptive statistics and correlation analyses. PT% displayed the most pronounced fluctuations, suggesting significant inter-individual variability potentially related to disease stage or external factors. The trends for INR and PT were closely aligned, consistent with their strong positive correlation. In contrast, the trend for FIB was distinct from most other parameters, reinforcing its relatively independent behavior.\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003e\u003cstrong\u003e【\u003c/strong\u003e\u003cstrong\u003ePrincipal Findings\u003c/strong\u003e\u003cstrong\u003e】\u003c/strong\u003eThis study identified significant correlations among coagulation parameters in tumor patients with gastrointestinal bleeding, notably the strong positive correlation between INR and PT, and the strong negative correlations of PT% with both INR and PT. FIB appeared to behave more independently. These findings offer insights into the complex coagulopathy associated with malignancy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e【\u003c/strong\u003e\u003cstrong\u003eRelationship with Pathophysiology\u003c/strong\u003e\u003cstrong\u003e】\u003c/strong\u003eThe observed distribution and correlation patterns may be closely linked to the pathophysiological state of tumor patients. Malignant cells can activate the extrinsic coagulation pathway by releasing tissue factor and cancer procoagulants, thereby influencing INR and PT\u0026nbsp;\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e4\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e. The near-perfect correlation between INR and PT (r=0.99) suggests that in this patient population, the drivers of change for these two parameters are highly congruent. The strong negative correlation of PT% with INR and PT may reflect a compensatory or regulatory mechanism, where the consumption or inhibition of prothrombin (reflected by decreased PT%) occurs in response to its excessive activation (reflected by prolonged PT and elevated INR)\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e5\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e. The relative independence of FIB suggests its regulation might be more strongly influenced by the systemic inflammatory response, a common paraneoplastic phenomenon, rather than by the same pathways that govern the PT/INR axis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e【\u003c/strong\u003e\u003cstrong\u003eClinical Significance and Implications\u003c/strong\u003e\u003cstrong\u003e】\u003c/strong\u003eThese findings have practical implications for clinical management. The combined assessment of strongly correlated parameters, such as INR and PT, could enhance the accuracy of bleeding risk prediction compared to evaluating a single parameter in isolation\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e6,\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e. Simultaneous elevation of INR and PT may signal a significant coagulation derangement warranting heightened vigilance and potential prophylactic intervention, even in the absence of overt bleeding. Furthermore, monitoring PT% alongside INR and PT could provide a more dynamic picture of coagulation status, as a declining PT% might foreshadow an increased bleeding risk before substantial changes in INR or PT occur. This integrated approach could guide more precise and timely adjustments to treatment plans, ultimately aiming to reduce the incidence of gastrointestinal bleeding. Patient education on recognizing bleeding signs and avoiding risk factors remains a crucial component of comprehensive care\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e8\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e10\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e【\u003c/strong\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003cstrong\u003e】\u003c/strong\u003eThis study has several limitations. First, its retrospective, single-center design may introduce selection bias. Second, the sample size (n=211), while reasonable, may not be sufficiently large to conduct robust subgroup analyses based on specific tumor type, stage, or histological grade, which are known to influence coagulation\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e11\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e. Third, we lacked data on potential confounders such as detailed treatment history (beyond the exclusion of recent therapy), comorbidities (e.g., liver disease, infection), and medications (e.g., anticoagulants, antiplatelet agents) that could significantly impact coagulation parameters. The absence of this information limits our ability to fully delineate the independent effects of the tumor itself.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e【\u003c/strong\u003e\u003cstrong\u003eFuture Research Directions\u003c/strong\u003e\u003cstrong\u003e】\u003c/strong\u003e Future research should address these limitations. Prospective, multi-center studies with larger, more diverse cohorts are needed to validate our findings. Stratified analyses by tumor type, stage, and histological subtype would help clarify the specific impact of different malignancies on coagulation\u0026nbsp;\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e12\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e. Comprehensive data collection should include detailed information on treatments, comorbidities, medications, and markers of inflammation to allow for multi-variable analysis and control of confounding. Long-term follow-up studies are essential to determine the prognostic value of baseline and dynamic changes in these coagulation parameters for predicting not only bleeding risk but also thrombotic events and overall survival\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e13-\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e\u003csup\u003e15\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e . Finally, integrating molecular biomarkers could help elucidate the underlying mechanisms linking tumor biology to coagulation dysregulation.\u003c/p\u003e\n\n"},{"header":"Conclusion ","content":"\u003cp\u003eIn conclusion, this study demonstrates a strong positive correlation between INR and PT and a strong negative correlation of PT% with both parameters in tumor patients with gastrointestinal bleeding. These findings underscore the interconnected nature of coagulation abnormalities in this context and suggest that a multi-parameter assessment, rather than reliance on any single index, may offer a more comprehensive and clinically useful evaluation of bleeding risk. While further research is warranted to confirm these findings and explore underlying mechanisms, our study provides a valuable foundation for integrating coagulation parameter correlations into risk stratification and clinical decision-making for tumor patients at risk of gastrointestinal bleeding.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Compliance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by [Medical Ethics Committee of the Second Affiliated Hospital of Xi\u0026apos;an Medical University\u003c/p\u003e\n\u003cp\u003e] (Approval No.: [2020LP03], Date: [2020.6.10]). The study was conducted in accordance with the ethical guidelines and regulations of the above‑mentioned ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and accordance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all the individual participants for participation in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and accordance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all the individual participants for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBai S ,Sun Y ,Xu H .Impact of Gastrointestinal Bleeding on Prognosis and Associated Risk Factors in Gastrointestinal Stromal Tumors: A Systematic Review and Meta-Analysis.[J].The American surgeon,2024,31348241307402.\u003c/li\u003e\n\u003cli\u003eBasahai I ,Alzeer A M ,Almuhanna S B .Successful treatment of gastric bleeding caused by left phrenic artery pseudoaneurysm post-surgery with endovascular embolization: A case report.[J].Radiology case reports,2024,19(6):2351-2356.\u003c/li\u003e\n\u003cli\u003ePatil G ,Kanetkar R S .Study of Coagulation Parameters in Gastrointestinal Malignancies.[J].Cureus,2024,16(10):e72162.\u003c/li\u003e\n\u003cli\u003eChen W ,Li Y ,Wang W , et al.Prognostic value of coagulation markers in patients with colorectal caner: A prospective study.[J].Health science reports,2024,7(2):e1553-e1553.\u003c/li\u003e\n\u003cli\u003eSuqin B ,Xiulin H ,Yongxin S , et al.Change in cytokine profiles released by mast cells mediated by lung cancer-derived exosome activation may contribute to cancer-associated coagulation disorders[J].Cell Communication and Signaling,2023,21(1):97-97.\u003c/li\u003e\n\u003cli\u003eSong Q ,Yang B ,Graham N , et al.The removal preference of Fe(III), Fe(II), and in situ Fe(III) in coagulation when treating NOM and TC[J].Separation and Purification Technology,2025,363(P2):132180-132180.\u003c/li\u003e\n\u003cli\u003ePeng Y ,Liu J ,Liu P , et al.Evaluating predelivery platelet and coagulation indices as predictors of immediate postpartum haemorrhage in low-risk women undergoing vaginal delivery.[J].BMC pregnancy and childbirth,2025,25(1):298.\u003c/li\u003e\n\u003cli\u003ePeng Q ,Zhu J ,Ren X .Thromboelastogram and coagulation function index: relevance for female breast cancer[J].Frontiers in Oncology,2024,141342439-1342439.\u003c/li\u003e\n\u003cli\u003ePeng Q ,Zhu J ,Zhang Y , et al.Blood hypercoagulability and thrombosis mechanisms in cancer patients -A brief review[J].Heliyon,2024,10(19):e38831-e38831.\u003c/li\u003e\n\u003cli\u003eSugawara N ,Iwatsubo T ,Mori Y , et al.Novel gel-immersion endoscopic injection sclerotherapy method for prophylactic hemostasis of esophageal varices: A pilot feasibility and safety study (with video).[J].DEN open,2025,5(1):e70056.\u003c/li\u003e\n\u003cli\u003eChoi J S ,Koo K Y ,Kim S , et al.Association of time to red blood cell transfusion on outcomes in patients with gastrointestinal bleeding.[J].Annals of medicine,2025,57(1):2474858.\u003c/li\u003e\n\u003cli\u003eSmeda M ,Maleki H E ,Jasztal A .A possible role of plasmin-dependent activation of TGF-\u0026beta; in cancer-associated thrombosis: Implications for therapy[J].Cancer and Metastasis Reviews,2024,44(1):2-2.\u003c/li\u003e\n\u003cli\u003eZhang Y ,Sun Z ,Wang Z , et al.Associations Between Inflammatory Indexes, Coagulation Indexes, and Fuhrman Grade of Clear Cell Renal Cell Carcinoma.[J].Annals of surgical oncology,2024,31(7):4185-4188.\u003c/li\u003e\n\u003cli\u003eSingh R S ,Kanamadi R G ,Thokchom B , et al.A study on the antioxidant, cytotoxicity, and coagulation potential of carbon quantum dots derived from the leaves of Lagerstroemia speciosa[J].Hybrid Advances,2025,10100430-100430.\u003c/li\u003e\n\u003cli\u003eKudo R ,Matsumoto K ,Ishiguro T , et al.Appendiceal cancer in pregnancy and circulating tumor cells detection in the umbilical cord[J].Heliyon,2025,11(3):e42411-e42411.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Digestive system neoplasms, Gastrointestinal hemorrhage, Gastrointestinal hemorrhage;Risk assessment","lastPublishedDoi":"10.21203/rs.3.rs-9356549/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9356549/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u0026nbsp;To investigate the correlation between gastrointestinal bleeding in tumor patients and various coagulation parameters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA retrospective analysis was conducted on 211 hospitalized tumor patients with gastrointestinal bleeding treated at multiple departments of our hospital over the past five\u0026nbsp;years. The analysis revealed significant differences in the distribution characteristics of the coagulation parameters. The percentage activity of prothrombin showed wide fluctuations, while fibrinogen levels were relatively concentrated. The international normalized ratio (INR) was strongly positively correlated with prothrombin time (PT), and the percentage activity of prothrombin was strongly negatively correlated with both INR and PT. Fibrinogen exhibited relatively weak correlations with other parameters.\u003c/p\u003e\n\u003cp\u003eResults:\u0026nbsp;The combined assessment of INR and PT is expected to improve the predictive accuracy for gastrointestinal bleeding risk in tumor patients. Monitoring changes in prothrombin activity percentage, in conjunction with INR and PT, may enable more timely detection of coagulation abnormalities, facilitating early clinical intervention and reducing bleeding risk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eINR is strongly positively correlated with PT, and prothrombin activity percentage is strongly negatively correlated with both. These findings are of great significance for predicting bleeding risk and guiding clinical management and future research.\u003c/p\u003e","manuscriptTitle":"Analysis and Research on Gastrointestinal Bleeding and Coagulation Indicators in Tumor Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 12:42:02","doi":"10.21203/rs.3.rs-9356549/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d47e88bd-ee5c-4991-b274-3a6acb002f57","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T13:55:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 12:42:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9356549","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9356549","identity":"rs-9356549","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}