Inpatients after COVID-19 infection, especially those admitted to intensive care unit (ICU), may encounter a series of coagulation dysfunction, which may lead to thrombosis, such as pulmonary embolism (PE), deep vein thrombosis (DVT) or arterial thrombosis (AT). Although there are many literatures on the incidence rate, prevention and treatment of venous thromboembolism (VTE) in hospitalized patients with COVID-19 infection, there are few data on the symptomatic and subclinical incidence rate of VTE after COVID-19 infection discharge. Therefore, there are no specific recommendations or guidelines for the prevention of VTE after discharge from hospital due to COVID-19 infection, and the current guidelines are controversial. In this study, we reviewed and summarized the existing literature on the incidence rate, prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19 infection, in order to provide guidance for VTE prevention in patients with COVID-19 infection after discharge.
Objective To summarize the general situation of perioperative venous thromboembolism (VTE) and summarize the perioperative antithrombotic strategies. Methods Domestic and international literatures and guidelines on antithrombotic therapy were collect and reviewed. Results VTE was common during the perioperative period. Reasonable assessment of each patient’s condition during the perioperative period, as well as reasonable use of anticoagulant, antiplatelet drugs, and hemostatic agents could reduce the incidence of VTE events during the perioperative period. Conclusions Clinicians need to properly assess the timing of the usage and discontinuation of antithrombotic drugs, weigh the risk of thrombosis and bleeding, develop a rational and scientific antithrombotic strategy based on the specific circumstances of each patient. Simultaneously, hemostatic agents need to be prescribed perioperatively to reduce the incidence of thromboembolic complications.
ObjectivesTo systematically review the efficacy and safety of new oral anticoagulants (NOACs) for cancer-associated venous thromboembolism.MethodsStudies about the efficacy and safety of NOACs versus low molecular weight heparins (LMWHs) or vitamin K antagonists (VKAs) for cancer-associated venous thromboembolism were collected by searching PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases from inception to August, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsA total of 8 studies involving 2 448 patients were included. The results of meta-analysis showed that: there was no significant difference in the recurrent VTE rate (OR=0.74, 95%CI 0.49 to 1.11, P=0.15) or bleeding rate (OR=0.80, 95%CI 0.57 to 1.13, P=0.21) between NOACs group and VKAs group. The major bleeding rate was significantly higher in the VKAs group than in the NOACs group (OR=0.47, 95%CI 0.27 to 0.84, P=0.01). The incidences of recurrent VTE (OR=0.84, 95%CI 0.16 to 4.14, P=0.83), bleeding (OR=0.46, 95%CI 0.18 to 1.20, P=0.11), major bleeding (OR=0.45, 95%CI 0.12 to 1.60, P=0.21) were similar between NOACs group and LMWHs group.ConclusionsThe current evidence indicates that for cancer patients with VTE, NOACs are superior to warfarin and comparable to LMWHs. Due to limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.
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.
Cerebral hemorrhage is a common clinical critical disease, and venous thromboembolism is one of its common complications. How to diagnose and treat venous thromboembolism early is still the main problem in the management of patients with cerebral hemorrhage. This article reviews the concept, pathogenesis, risk factors, evaluation tools, prevention and treatment of venous thromboembolism in patients with cerebral hemorrhage. Suggestions are put forward on the development of evaluation tools and improvement of prevention and treatment, in order to provide reference for clinical management and related research of patients with cerebral hemorrhage complicated with venous thromboembolism.
Objective To study the correlation of preoperative hemoglobin amount with venous thromboembolism (VTE) after surgical treatment of bronchiectasis and the clinical significance. Methods A retrospective study was performed on patients with bronchiectasis who underwent surgical treatment in our center from June 2017 to November 2021. The differences in blood parameters between the VTE patients and non-VTE patients were compared. The relationship between preoperative hemoglobin and VTE was confirmed by quartile grouping and receiver operating characteristic (ROC) curve. Results A total of 122 patients were enrolled, including 50 males and 72 females, with a mean age of 52.52±12.29 years. The overall incidence of VTE after bronchiectasis was 9.02% (11/122). Preoperative hemoglobin amount (OR=0.923, 95%CI 0.870-0.980, P=0.008) and D-dimer amount (OR=1.734, 95%CI 1.087-2.766, P=0.021) were independent influencing factors for VTE after bronchiectasis. The incidence of VTE after bronchiectasis decreased gradually with the increase of preoperative hemoglobin amount. The area under the ROC curve (AUC) of postoperative D-dimer alone was 0.757, whereas the AUC of postoperative D-dimer combined with preoperative hemoglobin amount was 0.878. Conclusion Low preoperative hemoglobin is an independent risk factor for postoperative VTE. Postoperative D-dimer combined with preoperative hemoglobin amount has a better predictive performance compared with postoperative D-dimer alone for postoperative VTE.
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.
ObjectiveTo comprehensively evaluate the incidence of venous thromboembolism (VTE) after colorectal surgery.MethodsWe searched PubMed/Medline, Web of science, and Embase databases by computer, collected studies by using the combination of corresponding English keywords. Then, we screened literatures according to inclusion and exclusion criteria, and evaluated the quality of literatures by using Downs and Black tools. Finally, we used Stata 15.1 and R Project 3.4.1 for meta-analysis.ResultsA total of 15 studies (n=721 730) were included in the meta-analysis. The combined incidence of VTE after colorectal surgery was 2.26% [95% CI was (1.93%, 2.61%), P<0.000 1], and the incidence of VTE after adjusting for publication bias was 1.82% [95% CI was (1.53%, 2.13%), P<0.000 1]. Meta regression analysis revealed that patients’ age (P<0.000 1), smoking (P=0.000 4), open surgery (P=0.020 0), preoperative albumin level (P=0.023 6), and malignant tumor (P=0.036 4) were correlated with the incidence of VTE after colorectal surgery, which may be potential factors for heterogeneity.ConclusionsThe incidence of VTE after colorectal surgery is not insignificant. It is necessary for clinicians to be vigilant about the occurrence of VTE after colorectal surgery and provide appropriate preventive interventions in combination with patients’ own risk factors, disease-related factors, and surgical factors.
ObjectivesTo systematically review the efficacy and safety of new oral anticoagulants (Apixaban, Rivaroxaban, or Dabigatran) after joint replacement.MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on new oral anticoagulants after joint replacement from inception to October, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 13 RCTs were included. The results of meta-analysis showed that compared to Enoxaparin, the new oral anticoagulant significantly reduced the incidence of asymptomatic deep vein thrombosis (DVT) (RR=0.60, 95%CI 0.46 to 0.78, P<0.000 1) and symptomatic DVT (RR=0.40, 95%CI 0.28 to 0.58, P<0.000 1), while the incidence of symptomatic pulmonary embolism (PE) during treatment (RR=0.91, 95%CI 0.59 to 1.39, P=0.65) and mortality (RR=1.00, 95%CI 0.40 to 1.76, P=0.99) were not reduced. Major bleeding (RR=1.05, 95%CI 0.81 to 1.35, P=0.72) and clinically relevant non-major bleeding events (RR=0.99, 95%CI 0.73 to 1.33, P=0.94) with new oral anticoagulants were not statistically different from Enoxaparin.ConclusionsCurrent evidence shows that new oral anticoagulants can effectively reduce the incidence of DVT in patients after joint replacement without increasing the risk of adverse events such as bleeding. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
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.