Objective To establish and validate a risk prediction model for post-thrombotic syndrome (PTS) in patients after interventional treatment for acute lower extremity deep vein thrombosis (LEDVT). MethodsA retrospective study was conducted to collect data from 234 patients with acute LEDVT who underwent interventional treatment at Xuzhou Central Hospital from December 2017 to June 2022, serving as the modeling set. Factors influencing the occurrence of PTS were analyzed, and a nomogram was developed. An additional 98 patients from the same period treated at the Xuzhou Cancer Hospital were included as an external validation set to assess the reliability of the model. ResultsAmong the patients used to establish the model, the incidence of PTS was 25.2% (59/234), while in the validation set was 31.6% (31/98). Multivariate logistic regression analysis of the modeling set identified the following factors as influencing PTS: age (OR=1.076, P=0.001), BMI (OR=1.163, P=0.004), iliac vein stent placement (OR=0.165, P<0.001), history of varicose veins (OR=5.809, P<0.001), and preoperative D-dimer level (OR=1.341, P<0.001). These 5 factors were used to construct the risk prediction model. The area under the receiver operating characteristic (ROC) curve (AUC) of the model was 0.869 [95%CI (0.819, 0.919)], with the highest Youden index of 0.568, corresponding to a sensitivity of 79.7% and specificity of 77.1%. When applied to the validation set, the AUC was 0.821 [95%CI (0.734, 0.909)], with sensitivity of 77.4%, specificity of 76.1%, and accuracy of 76.6%. ConclusionsThe risk prediction model for PTS established in this study demonstrates good predictive performance. The included parameters are simple and practical, providing a useful reference for clinicians in the preliminary screening of high-risk PTS patients.
ObjectiveTo investigate the incidence of perioperative deep venous thrombosis (DVT) of lower extremities and its risk factors in elderly patients with femoral neck fracture. Methods The clinical data of 4 109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, there were 1 137 males and 2 972 females; their ages ranged from 65 to 101 years, with an average of 77.0 years. The time from fracture to admission ranged from 1 to 360 hours, with an average of 35.2 hours. There were 1 858 cases of hemiarthroplasty, 1 617 cases of total hip arthroplasty, and 634 cases of internal fixation surgery. The preoperative age-adjusted Charlson comorbidity index (aCCI) was 4 (3, 5). Perioperative DVT occurred in 857 cases (20.9%). Univariate analysis was performed on age, gender, body mass index, fracture side, time from fracture to admission, operation type, anesthesia type, blood transfusion, blood pressure after admission, and preoperative aCCI in patients with and without perioperative DVT, and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture. ResultsUnivariate analysis showed that there were significant differences in age, gender, time from fracture to admission, operation type, and preoperative aCCI between the two groups (P<0.05). Further logistic regression analysis showed that age>75 years, female patients, time from fracture to admission>24 hours, and preoperative aCCI>5 were risk factors for perioperative DVT (P<0.05). Conclusion Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT. The advanced aged and female patients, patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.
Objective A prospective randomized controlled trial was conducted to study the effectiveness and safety of intravenous different doses tranexamic acid (TXA) in single-level unilateral minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods The patients treated with single-level unilateral MIS-TLIF between September 2019 and October 2020 were enrolled and randomly classified into low-dose TXA (LD) group (n=39), high-dose TXA (HD) group (n=39), and placebo-controlled (PC) group (n=38). The LD, HD, and PC groups received intravenous TXA 20 mg/kg, TXA 50 mg/kg, the same volume of normal saline at 30 minute before skin incision after general anesthesia, respectively. There was no significant difference on baseline characteristics and preoperative laboratory results among 3 groups (P>0.05), including age, gender, body mass index, surgical segments, hematocrit (HCT), hemoglobin (HGB), prothrombin time (PT), international normalized ratio (INR), D-dimer, fibrin degradation products (FDP), activated partial prothromboplastin time (APTT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), urea. The intraoperative blood loss (IBL), postoperative drainage volume, operation time, total blood loss (TBL), hidden blood loss (HBL), blood transfusion, hematological examination indexes on the first day after operation, and the incidence of complications within 1 month were compared among the 3 groups. Results There were 3, 2, and 4 patients in the LD, HD, and PC groups who underwent autologous blood transfusion, respectively, and there was no allogeneic blood transfusion patients in the 3 groups. There was no significant difference in IBL, postoperative drainage volume, and operation time between groups (P>0.05). The TBL, HBL, and the decreased value of HGB in LD and HD groups were significantly lower than those in PC group (P<0.05), and TBL and HBL in HD group were significantly lower than those in LD group (P<0.05); the decreased value of HGB between LD group and HD group showed no significant difference (P>0.05). On the first day after operation, D-dimer in LD and HD groups were significantly lower than that in PC group (P<0.05); there was no significant difference between LD and HD groups (P>0.05). There was no significant difference in other hematological indexes between groups (P>0.05). All patients were followed up 1 month, and there was no TXA-related complication such as deep venous thrombosis of lower extremity, pulmonary embolism, and epilepsy in the 3 groups. ConclusionIntravenous administration of TXA in single-level unilateral MIS-TLIF is effective and safe in reducing postoperative TBL and HBL within 1 day in a dose-dependent manner. Also, TXA can reduce postoperative fibrinolysis markers and do not increase the risk of thrombotic events, including deep venous thrombosis and pulmonary embolism.
Objective To study the significance of the levels of plasma inflammatory cytokines (IL-6，IL-8，IL-10 and TNF-α) in patients with acute deep venous thrombosis (DVT) of lower extremity. Methods Forty untreated DVT cases were selected as the subjects in the DVT group, while thirty healthy subjects, whose ages and genders showed no significant difference with the DVT patients, were collected as the control group. The plasma levels of IL-6, IL-8 and TNF-α were detected by radioimmunoassay (RIA), and the plasma level of IL-10 was measured by enzyme-linked immunosorbent assay (ELISA). Correlation analysis was used to investigate the relationships between the levels of different inflammatory cytokines within DVT group. Results The levels of plasma cytokines in the DVT group were all significantly higher than those in control group (P＜0.001). The results of the correlation analysis showed that there were positive correlations between IL-6 and TNF-α (r=0.383, P＜0.05), IL-10 and TNF-α (r=0.390, P＜0.05), respectively, within the DVT group; whereas there were no correlations between IL-6 and IL-8, IL-6 and IL-10, IL-8 and IL-10, and IL-8 and TNF-α. Conclusion The levels of plasma cytokines increased significantly in patients of DVT. Inflammatory cytokines may play an important role in acute DVT by accelerating the pace of thrombosis, intensifying the inflammatory reaction around thrombus and aggravating the injured blood vessel.
ObjectiveTo observe the effect of anti-embolism stocking and air pressure therapeutic apparatus on the prevention of lower extremity deep vein thrombosis (DVT) after pelvic floor reconstruction. MethodsNinety-one patients who were treated with pelvic floor reconstruction between June 2011 and May 2013 were divided into trial group (n=42) and control group (n=49) according to random number table method. The patient age, body mass index (BMI), level of education, general anesthesia and surgery time between the two groups had no difference of statistical significance (P>0.05). The control group was treated traditionally. The trial group used anti-embolism stocking 30 minutes before surgery, and from 6 hours after operation until 3 days later when the patient could walk with the combined use of pneumatic therapeutic treatment. Between day 5 and 7 after surgery, lower limb vascular color Doppler ultrasound was done to observe the occurrence of lower limb DVT in both the two groups. ResultsThe incidence of lower extremity DVT was 2.38% and 18.36% in the trial and the control group respectively. There was a statistically significant difference between the two groups (P<0.05). ConclusionCombined use of anti-embolism stocking 30 minutes before operation and pneumatic therapeutic treatment 6 hours postoperatively can be effective in preventing the formation of DVT after total pelvic floor reconstruction.
Objective To summarize the clinical manifestation and the causes of lower limb deep venous thrombosis （DVT） complicated with pulmonary embolism （PE）. Method The clinical data of 45 cases of PE confirmed by CTPA from May 2009 to May 2012 in this hospital were summarized retrospectively. Results Five patients with PE had no obvious clinical manifestation， 9 patients （20.0%） had chest stuffiness and short of breath， 8 patients （17.8%） had cough. In the causes of thrombosis defluxion：11 patients （24.4%） had early mobilization after operation， 9 patients （20.0%） had functional exercise after operation， 7 patients （15.6%） had turn over or defecate on bed， 2 patients （4.4%） had sneeze， 14 patients （31.1%） had no definite causes. Conclusions Patients with lower limb DVT have high risk of thrombosis defluxion， although adequate anticoagulation. Early mobilization， functional exercise， and transient increased abdominal pressure are easy to lead to thrombosis defluxion， so lead to PE. Absence of the protection of inferior vena cava filter， patient should be required for bed ridden in order to avoid the thrombosis defluxion.
ObjectiveTo explore the correlation between the Barthel index score and other factors with the preoperative occurrence of deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA) revision surgery. MethodsA retrospective analysis was conducted on clinical data from 122 patients who met the inclusion criteria and underwent THA revision surgery between April 2017 and November 2020. Among them, 61 were male and 61 were female, with an age range of 32-85 years (mean, 65.3 years). The reasons for revision included prosthetic joint infection in 7 cases, periprosthetic fracture in 4 cases, prosthetic dislocation in 6 cases, and aseptic loosening in 105 cases. The Barthel index score was 76.4±17.7, with 10 cases classified as level 1, 57 as level 2, 37 as level 3, and 18 as level 4. Univariate analysis was performed on variables such as age, gender, body mass index, Barthel index score, preoperative D-dimer positivity, history of diabetes, hypertension, cancer, cerebral infarction, smoking, and thrombosis in patients with and without preoperative DVT. Furthermore, logistic regression was used to identify risk factors for preoperative DVT in THA revision surgery. The incidence of preoperative DVT was compared among different Barthel index score groups. ResultsPreoperative DVT was detected in 11 patients (9.02%), all of whom had intermuscular venous thrombosis. Among them, 1 had prosthetic joint infection, 1 had periprosthetic fracture, 1 had prosthetic dislocation, and 8 had aseptic loosening. Univariate analysis showed significant differences between the two groups in terms of age, gender, and Barthel index score (P<0.05). logistic regression further revealed that female, age ≥70 years, and Barthel index score<60 were independent risk factors for preoperative DVT in patients undergoing THA revision surgery (P<0.05). The incidence of preoperative DVT in patients with Barthel index scores of levels 1, 2, 3, and 4 were 0 case (0%), 2 cases (3.5%), 3 cases (8.1%), and 6 cases (33.3%), respectively. A significant correlation was found between Barthel index score classification and the incidence of preoperative DVT in patients undergoing THA revision surgery (χ2=10.843, P=0.001). ConclusionIn patients undergoing THA revision surgery, older age, female, and lower Barthel index scores are associated with higher preoperative DVT incidence. For patients with low preoperative Barthel index scores, preoperative thrombosis screening should be emphasized.
Objective To improve the knowledge of inflammatory bowel disease complicated with venous thromboembolism for better diagnosis and treatment. Methods One case of patient with ulcerative colitis complicated with a multiple vessel thromboembolism ( pulmonary arterial, deep vein of lower limb, and superior mesenteric vein) was analyzed, and related literatures were reviewed. Results The patient resulted in pulmonary thromboembolism ( PTE) recurrence because of irregular treatment. In addition to deep vein thrombosis of the lower extremity, a new discovery of the superior mesenteric vein embolism ( MVT) was diagnosed. The bleeding risk of heparin or lowmolecular weight heparin ( LMWH) for treatment is low, while that of warfarin is high. Conclusions Venous thromboembolism ( VTE) has a close relationship with inflammatory bowel disease ( IBD) such as ulcerative colitis. The symptomis not so typical that it is easy to misdiagnosis and missed diagnosis. It is noted that mesenteric venous thrombosis ( MVT) should be excluded in IBD patients suffering from VTE, if the source of embolus is not clear. Suitable treatment should be considered according to the risk stratification of VTE and risk-benefit ratio because of a high bleeding risk.
Objective To analyze the relation between the mode of delivery and postpartum lower extremity deep venous thrombosis （DVT）， and discuss the therapy methods. Methods The clinical data of 48 patients with postpartum lower extremity DVT from 2006 to 2012 in this hospital were analyzed retrospectively. Results There were 15 897 patients with the delivery， of whom were 10 097 cases of cesarean section and 5 800 cases of spontaneous delivery， the incidence rate of lower extremity DVT in the patients with cesarean section was significantly higher than that in the patients with spontaneous delivery〔0.41% （41/10 097） versus 0.12% （7/5 800）， χ2=9.94，P＜0.005〕. The higher incidence rate of cesarean section， the higher incidence rate of lower extremity DVT， which was a positive correlation between them （rs=0.87，P＜0.05）. Forty-three cases were only treated by drug therapy， 2 cases were performed operation combined with drug therapy， and 5 cases were placed the inferior vena cava filter. Forty-eight cases were cured and discharged. Conclusions The incidence rate of lower extremity DVT of cesarean section is higher as compared with the spontaneous delivery. The thrombolysis and （or） anticoagulation therapy is an effective way in the treatment for DVT. Controlling indications of cesarean section and early postpartum out-of-bed can decrease the DVT.
Objective To investigate the short-term result of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (DVT) in lower extremity. Methods A total of 289 cases of acute DVT in lower extremity who got treatment in Nanjing Drum Tower Hospital Group Suqian City People’s Hospital and Xuzhou Central Hospital from March 2013 to December 2014 were enrolled prospectively, and of them, 125 cases of system thrombolysis (ST) group underwent ST, 164 cases of CDT group underwent inferior vena cava filter placement (IVCF)+CDT. Clinical effect was compared between the 2 groups. Results Clinical symptoms of all cases were obviously relieved, and limb swelling was significantly reduced. Of the CDT group, 73 cases presented iliac vein compression syndrome (IVCS), and 43 cases of them underwent the percutaneous transluminal angioplasty and stent implantation. In CDT group, there was 1 case complicated by catheter displacement, 10 cases suffered from puncture site ecchymosis, 3 cases suffered from hematuria. In ST group, there was 1 case suffered from pulmonary embolism (PE), 14 cases suffered from bleeding gums, 22 cases suffered from hematuria, 3 cases suffered from skin and mucosa petechia, and 2 cases suffered from melena (didn’t need transfusion). The morbidity of ST group was higher than that of CDT group (P=0.002). There were 18 cases suffered from recurrence in ST group, 15 cases suffered from recurrence in CDT group, but there was no significant difference in the recurrence rate between the 2 groups (P=0.786). In addition, the dosage of urokinase, thrombolysis time, blood vessel patency score, thigh circumference after treatment, and calf circumference after treatment in ST group were all higher than those of CDT group (P<0.050), but the Villalta score in ST group was lower than that of CDT group (P<0.001). There was no significant difference in hospital stay (P=0.383). Conclusion For acute DVT in lower extremity, CDT has a superior short-term outcome with safety and feasibility.