Objective To study the related risk factors for recurrence of venous thromboembolism （VTE）. Methods The literatures about the related factors for recurrence of VTE were searched. The relationships between the factors and recurrence of VTE were determined by meta-analysis. Results A total of 12 literatures were included. The results of meta-analysis showed that factors such as males， age＜50 years old， malignant tumor， and antiphospholipid syndrome related with the recurrence of the first VTE after treatment， but there were no correlation between the recurrence of VTE， the type of first VTE， and causes of VTE. Conclusions The recurrence of VTE correlate with various factors. In order to avoid the recurrence of VTE， the patients with the risk factors for recurrence of VTE should be appropriate to extend the duration of anticoagulation
ObjectiveTo develop a standardized venous thromboembolism (VTE) prevention program for burn patients and verify its safety and effectiveness by comparing with traditional thrombus prophylaxis.MethodsAll burn patients admitted and met selection criteria betweem April 2017 and September 2018 were included. Patients between January 2018 and September 2018 were included as the interventional group to implement standardized VTE prevention programs, while patients between April 2017 and December 2017 were included as the control group and traditional active and passive exercises were used to prevent VTE. There was no significant difference in the age, gender, ethnic group, marriage, education, occupation, type and site of the injury, burn area, operation time, and hospital stay between the two groups (P>0.05), which was comparable. The incidence of VTE, number of cases of tissue or organ hemorrhage, survival rate of skin grafting, and time of wound healing were compared.ResultsThe incidence of VTE was obviously lower in the interventional group (1.56%, 1/64) than in the control group (10.17%, 6/59) (χ2=−2.05, P=0.04). No bleeding occurred in any tissue or organ in the two groups. The survival rate of skin grafting and the time of wound healing were 89.06% (57/64) and (11.78±3.08) days respectively in the interventional group and 91.53% (54/59) and (11.66±2.30) days respectively in the control group; and the differences between the two groups were not statistically significant (χ2=0.21, P=0.65; t=−0.22, P=0.83).ConclusionThe standardized VTE prevention program can effectively prevent the occurrence of VTE, and its safety is relatively high.
ObjectiveTo analyze the predictive value of thrombelastogram (TEG) on venous thromboembolism in elderly patients undergoing cardiac surgery.MethodsA total of 64 patients with venous thromboembolism after cardiac surgery in our hospital from March 2014 to March 2018 were selected as a pathogenesis group, including 38 males and 26 females, aged 61-73 (67.3±5.8) years. And 158 patients without venous thromboembolism who underwent cardiac surgery during the same period were selected as a control group, including 82 males and 76 females, aged 59-75 (65.9±7.1) years. Routine coagulation parameters such as plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (D-D), platelet count (PLT) and various indicators of TEG were measured in two groups. The correlation analysis was performed on the obtained results, and the specificity and sensitivity of conventional coagulation indicators and TEG indicators for venous thromboembolism were analyzed and compared.ResultsThere were significant differences between the two groups in routine coagulation parameters and TEG (P<0.05). The area under the receiver operating characteristic (ROC) curve for each indicator was >0.5, which was of diagnostic significance. When the sensitivity>90%, the highest specificity value was also selected. The sensitivity and specificity of each indicator of TEG were greater than those of conventional coagulation indicators. The reaction time (R) was positively correlated with APTT in all indicators of TEG, and coagulation speed (K) was negatively correlated with Fib and PLT. Maximum thrombus intensity (MA) and Angle were positively correlated with Fib and PLT (all P<0.05). There was no correlation between TEG indicators and D-D.ConclusionThe TEG has higher predictive value for postoperative venous thromboembolism in elderly patients undergoing cardiac surgery than conventional coagulation tests. However, D-D level tests have unique diagnostic value in the diagnosis of venous thromboembolism.
Objective To systematically review venous thromboembolism (VTE) risk assessment tools. Methods The Embase, PubMed, CNKI, CBM, WanFang Data, VIP databases and 22 relevant institutions and associations were searched to identify all VTE assessment tools from inception to December 31, 2022. Two researchers independently screened the literature, extracted data, and cross-checked the data. A qualitative analysis was used to describe the country's essential characteristics, publishing organization, year, applicable disease type, applicable population, tool formation method, etc. Key elements and techniques were compared in terms of evaluation dimension, methods, and procedures to form the tool, risk stratification ability, and whether to verify. Results A total of 42 VTE risk assessment tools were included, of which 16 were in the United States, and only 4 were in China. They were released between 1996 and 2021, and the applicable disease types and populations differ. Nineteen tools were constructed based on case-control or retrospective cohort studies, 16 were conducted using prospective cohort studies, and 5 were based on cross-sectional and RCT studies; Additionally, 20 tools were built based on logistic regression models; The evaluation dimensions of each tool differed, and the most common frequency of occurrences were VTE history, age, BMI value, and confirmed tumor, accounting for 64.29%, 54.76%, 54.76%, and 47.62%, respectively. Thirty-three tools were stratified for risk, and 30 tools were presented in the form of risk scores; Some tools lacked clinical validation data, and only 12 tools were analyzed for specificity, sensitivity, NPV, PPV, and AUC. Conclusion The evaluation dimensions and evidence sources of existing VTE risk assessment tools are not completely consistent, the implementation methods and results presentation forms of the tools are not completely the same, and the scope of application is different; Some tool construction methods and processes are not clear enough, and there is a lack of validation research on external validity, which has certain limitations in promoting clinical practice in China.
Objective To investigate the prevalence and risk factors of venous thromboembolism ( VTE) in patients with acute exacerbation of COPD ( AECOPD) . Methods The patients with AECOPD admitted fromJune 2006 to February 2010 in Beijing Tongren Hospital were included for analysis. VTE was investigated in all patients ( whether or not clinically suspected) by a standardized algorithm based on D-dimer testing, 4-limb venous ultrasonography, and the patients with clinically suspected pulmonarythromboembolism ( PTE) received ventilation/perfusion scan and ( or) computed tomography pulmonary angiography ( CTPA) . Results The total number of patients with AECOPD was 282, and the prevalence of VTE was 6% ( 17 /282) . Among the hypoxemia group( n = 84) , there were 16 patients with DVT with a prevalence of VTE of 19. 1% ( 16/84) in which 3 cases developed with PTE. In the non-hypoxemia group ( n =198) , the prevalence of VTE was 0. 5% ( 1/198) , and there was no case with PTE. The incidence of VTE in the hypoxemia group was significantly higher than that in the non-hypoxemia group( P lt; 0. 01) .Logistic analysis showed that lower PaO2 was the risk factor for VTE ( P lt; 0. 01 ) . Conclusions The incidence of VTE in AECOPD was 6% , mainly in the form of lower limb DVT. Hypoxemia was the risk factor for VTE in patients with AECOPD.
Objective To investigate whether antipsychotic drugs will increase the risk of venous thromboembolism (VTE) and pulmonary embolism (PE), and to provide evidence for the prevention of VTE and PE in patients with APs exposure. Methods Databases including PubMed, Web of Science, CNKI, VIP and Elsevier were searched from inception to July 2016 to collect case-control studies and cohort studies on the association between APs exposure and the risk of VTE and PE. The literature were screened according to the inclusion and exclusion criteria, the data were extracted and the bias risk of the included studies were evaluated by two reviewers independently. The Meta-analysis was performed by using Stata 12 software. Results Nineteen studies were included. The results of meta-analysis showed that APs exposure was associated with VTE (OR=1.50, 95%CI 1.30 to 1.74,P<0.001). Exposure to low-potency FGA (OR=2.28, 95%CI 1.02 to 5.10,P=0.045), high-potency FGA (OR=1.68, 95%CI 1.37 to 2.05,P<0.001) and SGA (OR=1.74, 95%CI 1.24 to 2.44,P=0.001) revealed an increased risk of VTE. Exposure to APs also signi?cantly increase the risk of PE (OR=3.69, 95%CI 1.23 to 11.07,P=0.02), especially exposure to FGA (OR=2.54, 95%CI 1.22 to 5.32,P=0.013), but exposure to SGA could not revealed an increased risk of PE. Conclusion FGA and SGA exposure maybe associated with an increase in the risk of developing VTE. And exposure to the FGA could increase the risk of PE. The occurrence of VTE and PE should be monitored when taking Aps.
ObjectiveTo analyze the risk factors of venous thromboembolism (VTE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and to provide a theoretical basis for the prevention and treatment of AECOPD combined with VTE.MethodsA total of 413 AECOPD patients admitted to Pulmonary Department of Pulmonary Hospital and our hospital from February 2014 to September 2017 were selected as the study subjects. The patients of AECOPD with VTE were determined by the results of lower extremity venous ultrasound and CT pulmonary angiography. The incidence of AECOPD patients with VTE was calculated. Patients with AECOPD with VTE were assigned to the VTE group and AECOPD without VTE to non-VTE group. All the patient's gender, age and other general information, lower extremity pain swelling, walking difficulties, fever and other clinical symptoms, bed rest, hormone use, diuretic use of treatment information, laboratory tests and other indicators were collected. SPSS 20.0 was used for statistical analysis. T-test or rank sum test was used to compare between groups. Chi-square test was used to count data, and the results of univariate analysis were included in logistic regression analysis to analyze the risk factors of VTE in patients with AECOPD.ResultsThe incidence of VTE in patients with AECOPD was 12.59%. Increasing heart rate, pulmonary infarction "triple symptoms" the proportion of PTE patients with higher than the number of patients with deep vein thrombosis (DVT), the difference was statistically significant (P<0.05). PaO2, PaCO2, SpO2, and FEV1%pred in PTE patients of PTE were lower than those in DVT patients, pulmonary artery systolic pressure was higher than DVT patients, the difference was statistically significant (P<0.05). History of venous thrombosis (OR=1.986, P=0.031), lower extremity pain (OR=7.376, P=0.019), bed-staying duration≥3 d (OR=3.325, P=0.001) and D-dimer increase (OR=9.628, P=0.000) were independent risk factors for VTE in AECOPD patients.ConclusionsThe incidence of AECOPD patients with VTE is high, which needs to be paid attention. Observation should be enhanced for those AECOPD patients with risk factors such as history of venous thrombosis, lower extremity pain, bed-staying duration≥3 d and D-dimer increase in clinical work. If possible, imaging studies should be carried out as soon as possible to make early diagnosis.
Objective To investigate the effectiveness and safety of low molecular weight heparin combined with aspirin for perioperative prophylactic anticoagulation in patients with lower extremity fracture after splenectomy. MethodsThe clinical data of 50 patients with splenic rupture combined with lower extremity fracture between January 2009 and June 2022 were retrospectively analyzed. All patients were given enoxaparin sodium at 48 hours after splenectomy, and stopped at 24 hours before fracture surgery. After fracture surgery, the patients were divided into aspirin group (group A, 15 cases), low molecular weight heparin group (group B, 16 cases), and low molecular weight heparin combined with aspirin group (group C, 19 cases) according to different anticoagulation regimens. The treatment course was 28 days. There was no significant difference in gender, age, body mass index, cause of injury, fracture site, time from injury to operation, complications, and other general data between groups (P>0.05). The occurrence of venous thromboembolism (VTE) was observed; hemoglobin (Hb), platelet (PLT), D-D dimer, and fibrinogen degradation product (FDP) were recorded before operation and at 1, 3, and 7 days after operation, and the effect of anticoagulation regimen on coagulation function was observed. The incidences of wound complications and bleeding related complications were recorded, and the total perioperative blood loss, hidden blood loss, and overt blood loss were calculated. Results The incidences of VTE in groups A, B, and C were 13.33% (2/15), 12.50% (2/16), and 5.26% (1/19), respectively, and there was no significant difference between groups (χ2=0.770, P=0.680). There was no portal vein thrombosis and no VTE-related death in the 3 groups. There was no significant difference in the levels of Hb, PLT, D-D dimer, and FDP between groups before and after operation (P>0.05); and there was no significant difference in total perioperative blood loss, hidden blood loss, and overt blood loss between groups (P>0.05). No local skin necrosis was found in all patients. In group A, 1 case occurred redness and swelling of incision; in group B, 1 case had incision discharge, redness, and swelling, and 1 case had fat liquefaction; in group C, 1 case had repeated incision exudation accompanied by local tissue redness and swelling, and 1 case had local hematoma. The incidences of adverse incision in groups A, B, and C were 6.66% (1/15), 12.50% (2/16), and 11.76% (2/19), respectively, with no significant difference (χ2=0.302, P=0.860). There were 4 cases of bleeding related complications, including 1 case of incision ecchymosis in groups A and B respectively, with the incidence of 6.66% and 6.25%, respectively; there was 1 case of incision hematoma and 1 case of bleeding in group C, with the incidence of 11.76%; showing no significant difference in the incidence of bleeding related complications between groups (χ2=0.268, P=0.875). Conclusion Perioperative combined use of low molecular weight heparin and aspirin for prevention of anticoagulation in patients with splenic rupture and lower extremity fracture can effectively prevent the occurrence of VTE without increasing the incidence of complications, which is an effective and safe treatment method. However, whether the incidence of VTE can be reduced needs to be further studied by expanding the sample size.
ObjectiveTo explore the causal association between venous thromboembolism (VTE) and cardiovascular disease (CVD) risks using a two-sample bidirectional Mendelian randomization (MR) study. MethodsThe single-nucleotide polymorphism (SNP) data associated with VTE and CVD from genome-wide association studies were obtained as instrumental variables. Inverse variance weighted (IVW) was used as the main MR method and other methods were used as supplementary methods. Cochran's Q test, the intercept term of MR-Egger, and MR-PRESSO were used to assess pleiotropy and heterogeneity to ensure the robustness of the results. ResultsThe IVW method suggested a causal association between VTE and atrial fibrillation (OR=1.033, 95%CI 1.009 to 1.058, P=0.008), but no association was identified between VTE and coronary artery disease (OR=0.994, 95%CI 0.974 to 1.023, P = 0.551), heart failure (OR=1.021, 95%CI 0.992 to 1.050, P=0.159) and myocardial infarction (OR=1.012, 95%CI 0.971 to 1.055, P=0.568). The results of Cochran's Q test showed that there was no heterogeneity in the MR analyses of VTE and CVD. The MR-Egger intercept analysis and the MR-PRESSO global testing did not detect potential horizontal pleiotropy, and the results were robust. Reverse MR analysis was used to verify the presence of reverse causal associations. The reverse MR analysis demonstrated that reverse causal associations between VTE and CVD were not evidenced. ConclusionThe results of the MR study demonstrated a causal association between VTE and atrial fibrillation, but not with coronary artery disease, heart failure or myocardial infarction.
ObjectiveTo evaluate the venous thromboembolism (VTE) risk and anticoagulant therapy in patients with coronavirus disease 2019 (COVID-19).MethodsThe patients with COVID-19 in Optics Valley Hospital of Wuhan Tongji Hospital from February 9, 2020 to March 29, 2020 were collected and analyzed. Padua scores were performed within 24 hours after admission. The relationship between Padua score, disease severity and 28 day prognosis was analyzed.ResultsCOVID-19 was diagnosed in 102 cases. The age, fibrinogen and mortality of the severe group were significantly higher than those of the common group. The Padua score of the severe group was higher than that of the common group, but there was no statistical difference. The platelet count in the critical group was significantly lower than that in the severe group, while the prothrombin time (PT), activated partial thromboplastin time (APTT), and D dimer were significantly higher than that in the severe group, and the Padua score, anticoagulation ratio, and mortality were significantly higher than those in the severe group. According to Padua score 4, it was divided into VTE high risk group (≥ 4 points) and VTE low risk group (<4 points). The mortality, APTT, D dimer and fibrinogen of high risk group were significantly higher than those of low risk group. In the high-risk group of VTE, the anticoagulation rate was significantly higher than that in the low-risk group of VTE, but it was still only 41.7%. The mortality of patients with anticoagulation was lower than that of patients without anticoagulation.ConclusionsSevere and critical novel coronavirus pneumonia patients have obvious coagulation dysfunction and high risk of VTE. Anticoagulant therapy may be associated with low mortality in patients with high risk of VTE, but the proportion of drug-induced anticoagulant intervention still needs to be improved.