Objective To investigate the value of different imageology methods in the diagnosis of acute pulmonary thromboembolism (PTE).Methods 22 cases diagnosed acute PTE in the last two years were retrospectively analysed，including 4 cases diagnosed by clinical signs and symptoms who did not perform further examinations due to severity of the disease (2 cases confirmed by autopsy)，18 cases diagnosed by either two methods of computed tomographic pulmonary angiography (CTPA)，ultrasound，radioisotope scanning of lung and pulmonary arteriography.The diagnostic positive rate of different methods were measured.Results 15 of the 18 subjects were performed CTPA，with a positive rate of 80.0% (12/15).Nuclide detection was performed in 14 cases，in which 5 cases were performed simple pulmonary infusion scanning，9 cases by lung ventilation/perfusion scanning，resulted in a positive rate of 92.9% (13/14).10 cases were performed nuclide phlebography on the low extremity simultaneously，deep phlebothrombosis was found in 5 subjects，and unnormal formation of collateral circulation，blocked blood circulation，stenosis of lumens，and valve disfunction et al were found in other 5 cases.16 cases were performed heart color ultrasound detection，in which 2 were found normal，one was directly found thrombus，and the other 8 cases were found indirect manifestations of acute PTE，including right ventricular enlargement，pulmonary artery hypertension，tricuspid backstreaming et al，with a diagnosing rate of 56% (9/16).Deep phlebothrombosis was found in 6 of the 10 cases who were performed color Doppler ultrasonography on the lower extremity，and one was found with valve function impaired.Conclusions CTPA possesses high positive rate in diagnosing acute PTE with promptness，convenience and reliability，thus can be taken as the front-line detection device.Radioisotope scanning of lung associated with same-time phlebography on the low extremity also has fairly high positive rate to diagnosing acute PTE and make it easy.
Objective To evaluate the prognostic value of several indexes of laboratory and ultrasonic cardiogram for adverse events in 3 months following the diagnosis of acute non-high-risk pulmonary embolism. Methods A total of 266 cases of acute non-high-risk pulmonary embolism patients diagnosed and treated in Beijing Anzhen Hospital during 2016 to 2017 were retrospectively analyzed. The patients were divided into a bad event group and a control group according to whether there was a bad event happened in 3 months following the diagnosis. The general data, indexes of laboratory and ultrasonic cardiogram were compared. Univariate and multivariate COX regression analysis were conducted to explore independent risk factors for 3 months’ poor prognosis. Results The bad outcome group had a significantly higher value of the proportion of suffering from connective disease and active cancer, C-reaction protein, monocyte/lymphocyte ratio (MLR) and urea while a significantly lower level of red blood cell count and hemoglobin compared with the control group (all P<0.05). Univariate and multivariate COX regression analysis showed that both the MLR (hazard ratio 14.59, 95% confidence interval 1.48 - 143.69, P=0.02) and suffering from connective disease (hazard ratio 5.85, 95% confidence interval 1.11 - 30.81, P=0.04) remain significantly different between the bad events group and the control group. Conclusion MLR at the admission may be related to the 3 months death of acute non-high-risk pulmonary embolism.
ObjectiveTo evaluate efficacy and safety of early anticoagulation therapy with low molecular weight heparin (LMWH) in prevention of venous thromboembolism (VTE) after pancreatoduodenectomy (PD).MethodsThe patients who received PD in our hospital from January 2017 to December 2018 were collected retrospectively, then were divided into the anticoagulant group and the non-anticoagulant group. The operation time, intraoperative blood loss, tumor property, coagulation function indexes such as prothrombin time (PT), PT activity (PTA), fibrinogen (FIB), activated partial thromboplastin time (APTT), thrombin time (TT), and D-dimer (DD), platelet (PLT), VTE, bleeding related complications etc. were compared between the two groups.ResultsA total of 103 patients underwent PD were included in this study, including 52 patients in the anticoagulant group and 51 patients in the non-anticoagulant group. There were no significant differences in the baseline data such as the gender, age, and preoperative coagulation function indexes, etc. between the two groups (P>0.05). The incidence of VTE in the anticoagulant group was lower than that in the non-anticoagulant group (13.5% versus 47.1%, P<0.001). There was no significant difference in the incidence of bleeding between the anticoagulant group and the non-anticoagulant group (9.6% versus 7.8%, P>0.05). There were no statistically significant differences in the coagulation indexes between the two groups before operation and day 1 after operation (P>0.05). On day 8 after operation, the FIB and DD values of the anticoagulant group were significantly lower than those of the non-anticoagulant group (P values were 0.040 and 0.002, respectively). A comparison of different phases in the same group on coagulation indexes between day 8 and day 1 after surgery showed that there were statistically significant differences (P<0.05), the changes of all indexes were within the normal range.ConclusionThe results of this study indicate that LMWH administered at 24 h after PD could decrease incidence of VTE and don’t increase risk of bleeding.
Patients with thoracic malignancy have a high incidence of perioperative venous thromboembolism (VTE), but its onset is insidious, often asymptomatic or atypical, and is easily overlooked. Early identification and standardized prevention of VTE can effectively reduce the risk of VTE. "Guideline for the prevention and management of perioperative venous thromboembolism in thoracic malignancies in China (2022 version)" has been officially released recently. This article closely follows the context, significance, core implications, and the impact of future VTE prevention in thoracic surgery. It is hoped that through our joint efforts, we can reduce the incidence of perioperative VTE and mortality of thoracic surgery, and strive to improve the long-term survival of patients with lung cancer and esophageal cancer.
ObjectiveTo summarize the current research progress on the relationship between thyroid cancer and venous thromboembolism.MethodsRetrieved the literatures about risk factors associated with thyroid cancer and venous thromboembolism both at home and abroad in recent years and reviewed the literatures.ResultsThe incidence of venous thromboembolism in patients with thyroid cancer was not high, and there were few factors related to risk factors, it might be related to the age of patient and the time of diagnosis of thyroid cancer. In addition, various types of therapeutic drugs for thyroid cancer might lead to the occurrence of venous thromboembolism.ConclusionsThe study of thyroid cancer and venous thromboembolism related factors and prethrombotic state occurrence are necessary to reduce the incidence of venous thromboembolism in thyroid cancer and improve prognosis.
Venous thromboembolism (VTE), comprising both deep vein thrombosis and pulmonary embolism, is a chronic illness that contributes significantly to the global burden of disease. The American College of Chest Physicians (ACCP) published the 9th edition of antithrombotic treatment guidelines for VTE (AT9) in 2012, which was first updated in 2016. In October 2021, ACCP published the 2nd update to AT9, which addressed 17 clinical questions related to VTE and presented 29 guidance statements in total. In this paper we interpreted the recommendations proposed in this update of the guidelines.
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.
Objective Pulmonary thromboembolism ( PTE) is associated with various risk factors which existed in multidisciplinary patients. It is necessary to know what the role of pulmonologists in the diagnosis of PTE. Methods Data were collected from thirteen general hospitals in Guangxi. Hospital records of PTE cases from1995 to 2007 were retrospectively analyzed. The rates of PTE to inpatients between the respiratory departments and other departments or between different periods were compared. Results The rates of PTE of inpatients in respiratory departments ( 1. 55‰, 170/109 577) was higher than that in other departments ( 0. 03‰, 69/2 322 944) , P lt; 0. 001. Compared to that of 1995-2001, the rate of PTE of inpatients in the respiratory departments in the last 6 years increased by 3220. 22% [ ( 2. 43‰,167/68 638) vs ( 0. 07‰, 3 /40 939) ] . During 1995-2001 and 2002-2007, the rates of PTE of inpatients in the respiratory departments were higher than those in other departments [ 0. 004‰ ( 4/1 012 830) during 1995-2001 and 0. 05‰( 65 /1 310 114) during 2002-2007, respectively] , P lt; 0. 01. Conclusion pulmonologists play an important role in the diagnosis of PTE in the recent years.
ObjectiveTo explore the predictive value of the maximum amplitude (MA) in the thromboelastogram (TEG) in the occurrence of venous thromboembolism (VTE) in patients with lung cancer after surgery.MethodsForty-one lung cancer patients with postoperative VTE in our hospital from September 2018 to August 2020 were enrolled into a thrombosis group, including 25 males and 16 females, aged 72.17±10.08 years. The 87 lung cancer patients who underwent surgery during the same period but did not suffer postoperative VTE were enrolled into a control group, including 51 males and 36 females, aged 71.06±9.49 years. The MA of thrombus in the TEG before and after the operation was compared between the two groups, and logistic regression analysis was used to test the value of the MA of thrombus at each time point in the TEG to predict the occurrence of VTE in patients with lung cancer surgery. The receiver operating characteristic curve was drawn to test the effectiveness of the MA of thrombus at each time point in the TEG to predict the occurrence of VTE in patients with lung cancer.ResultsThe MA of thrombus in the two groups after operation was greater than that before operation, and the MA of thrombus in the TEG on the day 3 after operation in the two groups> day 1> day 5 (P<0.05). The logistic regression analysis showed that the MA of thrombus in the TEG increased, which had predictive value for the occurrence of VTE in patients with lung cancer after surgery; the MA of thrombus in the TEG at each postoperative point was used as the test variable. Taking the occurrence of VTE as a state variable, the area under the curve (AUC) of MA of thrombus in the TEG on the 1st postoperative day was 0.82, and its optimal threshold was 75.15 mm; on the 3rd postoperative day, AUC was 0.88, and its optimal threshold was 80.05 mm; on the 5th day afterwards, AUC was 0.78, and its optimal threshold was 66.30 mm.ConclusionThe MA of TEG has a high predictive power for the occurrence of VTE in lung cancer patients after surgery, which suggests that TEG dynamic monitoring should be performed before surgery for lung cancer patients, and a reasonable anticoagulation plan should be formulated accordingly to reduce the occurrence of VTE.
Abstract: Objective To investigate the clinical features, differential diagnosis, surgical treatment and outcome of primary pulmonary artery sarcoma. Methods Between January 1994 and December 2004, 5 patients with primary pulmonary artery sarcoma were identified at operation and treated by surgical resection. Pulmonary valve stenosis were initially diagnosed in 3 patients, and chronic pulmonary embolism were initially diagnosed in 2 patients. Tumor resection from the vascular bed was performed in 1 patient and tumor resection and homograft reconstruction of pulmonary arteries were performed in 4 patients. Results One patient died of postoperative refractory pulmonary hypertension, 2 patients died 4 months after operation because of brain metastases, 1 patient was alive for 9 months after operation with recurrent pulmonary tumor, and 1 patient was alive for 2 years after operation without clinical or radiological signs of tumor recurrence or metastasis. Histological examinations showed 4 malignant mesenchymomas and 1 fibrosarcoma. Conclusions Primary pulmonary artery sarcomas are rare and usually fatal tumors of the cardiovascular system. The diagnosis is difficult and this disease is frequently misdiagnosed as chronic pulmonary hromboembolism and pulmonary valve stenosis. Early diagnosis can be improved by computerized tomography scanning and magnetic resonance imaging. Radical surgical resection was the most effective modality for shortterm palliation. The prognosis of pulmonary artery sarcoma is poor. The survival time after resection varies from several months to several years depending on the presence of recurrence or metastasis.