ObjectiveTo investigate the risk factors,characteristics and prognosis in Tibetan patients with venous thromboembolism. MethodsTibetan patients with VTE from plateau area,admitted in West China Hospital from January 2010 to December 2012,were recruited in the study. The VTE diagnosis was confirmed by CT pulmonary angiogram (CTPA) or vascular ultrasound examination. Risk factors,clinical symptoms,signs and laboratory tests were retrospectively investigated and follow-up by telephone interview was conducted. Results31 Tibetan VTE patients with 16 males and 15 females were included. The investigation of risk factors revealed that 15 patients suffered from obese(48.3%),10 patients suffered from highly viscous hyperlipidemia(32.3%). The most common clinical symptom was dyspnea(29%),followed by chest pain(19.4%),hemoptysis(16.1%) and cough(12.9%). The common signs were lower extremity edema(73.3%) and lung rale(36.7%). All the patients received anticoagulation therapy,and inferior vena caval filters were implanted in 2 patients. In two years' follow-up after discharge,2 patients died of tumor,2 died of pulmonary embolism,6 patients suffered from chronic embolization syndrome with lower extremity edema or pain,1 patient suffered from pulmonary hypertension after embolization,and thrombus in 20 patients disappeared or recanalized. ConclusionTibetans long-termly reside in high altitude areas with the eating habits of high-fat diet,which may increase the incidence of acquired risk factors such as viscous hyperlipidemia and obesity. There are no specific clinical symptoms and signs among Tibetan VTE patients,with dyspnea as the most common symptom and lower extremity edema as the most common sign. Patients with risk factors which can be eliminated in a short term have better prognosis.
ObjectiveTo explore the value of potaried technique with Trivex system in treatment for venous skin ulcer with deep venous thrombosis sequelae (DVTS) of lower limbs. MethodsTotal 166 patients with venous skin ulcer with DVTS of lower limbs were included in this study. The patients of operation group (94 patients involving 94 legs) were treated by using potaried technique with Trivex system. The patients of nonoperation group (72 patients involving 72 legs) were treated by using nonoperative method. The clinical indexes of skin infection rate, skin necrosis rate, shrinkage rate of wound area, skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were used to assess the clinical curative effect between two groups on 5, 20, 120 and 360 d after operation or treatment, respectively. ResultsThere were no skin infection and skin necrosis in two groups on 5 d after operation or treatment. The rate of shrinkage of wound area and skin depigmentation of patients in operation group were significantly higher than those in nonoperation group on 20 d after operation or treatment 〔(95.8±2.138)% vs. (68.7±3.125)%，P=0.048; (87.6±1.263)% vs. (12.3±1.324)%， P=0.018〕. The rate of the ulcer healing of patients in operation group was significantly higher than that in nonoperation group on 120 d after operation or treatment (97.9%vs. 8.3%， P=0.014). The rate of the ulcer recurrence of patients in operation group was significantly lower than that in nonoperation group on 360 d after operation or treatment (5.3% vs. 97.2%， P=0.015). ConclusionThe potaried technique with Trivex system can be used as one of the surgical treatment methods for venous skin ulcer with DVTS of lower limbs.
【Abstract】 Objective To improve the knowledge of pulmonary embolism with normal D-dimer levels. Methods Nine consecutive patients of established pulmonary embolism with a normal D-dimer concentration admitted from January 2004 to December 2009 were analyzed retrospectively. Results Pulmonary embolism was confirmed in the 9 patients with a normal D-dimer concentration. Pulmonary embolismwas confirmed in only one patientwith an unlikely probability of pulmonary embolism. Wells score was 3 and the localization of the emboli was segmental emboli. In other 8 patients with a likely clinical probability of pulmonary embolism, the complaints of those patients existed between 1 hour and 2 months.Wells score was between 4. 5 and 7. 5, with a median of 6. 0. D-dimer concentration was between 0. 1 and 0. 5 mg/L, with a median of 0. 3 mg/L. The localization of the emboli was sub-segmental emboli in 3 cases,segmental emboli in 4 cases, and central emboli in 2 cases. Conclusions Our findings indicate that it is essential to examine the patient and assess the clinical probability at the first, then the D-dimer concentration should be taken into account. In patients with a likely clinical probability, a normal D-dimer test result can not exclude pulmonary embolism, and additional imaging testing is necessary.
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 effect of arteriovenous impulse system (AVIS) combined with lowmolecular-weight heparins calcium (LMWHC) for prophylaxis of deep vein thrombosis (DVT) following total knee arthroplasty (TKA). Methods From March 2006 to March 2008, 76 cases of osteoarthritis patients (76 knees) accepted TKA, including 25 males and 51 females with an average age of 66.6 years (range, 58-79 years). The affected knees were left side in 41 cases and right side in 35 cases. They were randomly divided into experimental group and control group before surgery. Then LMWHC and rehabil itation training were routinely given in two groups before and after surgery. However, only experimental group was treated with AVIS continually during the first four days and then two times a day for 30 minutes one time during 5-7 days. At 7 daysd after operation, color Doppler ultrasound was used to detect the occurrence condition of DVT. Results Five cases (13.16%) had thrombosis of calf and recovered after treated with urokinase and salvia in the experimental group. Eleven cases had thrombosis of calf and 3 cases had thrombosis of whole low extremities (36.84%), and improved after treated with urokinase and salvia in the control group. There was significant difference in DVT incidencerate between two groups (P lt; 0.05). No pulmonary embol ism or death was found in both groups. Conclusion AVIScan effectively accelerate the venous blood return velocity, a combination of AVIS and LMWHC has a better effect in theprevention of DVT following TKA.
To evaluate the efficacy and safety of comprehensive prophylaxis for deep venous thrombosis(DVT) after proximal femur fractures in geriatric patients. Methods From July 2003 to May 2006, 157 geriatric patients with proximal femur fractures treated with operation were divided into prophylaxis group and control group randomly. There were 82 patients (34 males, 48 females, aged 65-97 years) in prophylaxis group, 30 with femoral neck fracture and 52 with intertrochanteric fracture of femur. There were 75 patients (33 males, 42 females, aged 65-94 years) in control group, 28 with femoral neck fracture and 47 with intertrochanteric fracture of femur. In the prophylaxis group, comprehensive prophylaxis for DVT which included Aspirin, fibrinolytic enzyme, passive and active circumduction of the foot and ankle, CPM management wasappl ied. In the control group, no thromboproxylaxis was taken. All patients in the both groups received color doppler flow imaging (CDFI) examination before operation and on the 7th and 14th days after operation. Results CDFI found 2 cases of DVT in the prophylaxis group 7 and 14 days after operation respectively, while 21 and 15 cases of DVT in the control group respectively. The incidence of DVT was 48.0% in the control group compared with 4.9% in the prophylaxis group and the reduction was significant (P lt; 0.01). One patient gave up the intervention due to Melena 3 days after operation in the prophylaxis group. In the control group, 1 patient died 8 days after operation and another died 11 days after operation. Both died of acute pulmonary embol ism confirmed by autopsy. Conclusion The comprehensive prophylaxis can significantly decrease the incidence of DVT in geriatric patients after proximal femur fractures. There is no significant adverse effect during the intervention.
OBJECTIVE: To investigate the effect of intermittent pneumatic compression on prevention of deep venous thrombosis after operation of lower limbs. METHODS: From Oct. 1997 to Aug. 1998, forty cases were received Doppler examination preoperatively, which showed no deep venous thrombosis in all the lower limbs of 40 cases. Among them, 24 cases were received total hip arthroplasties, 4 cases were received total knee arthroplasties and 12 cases were received dynamic hip screw. Postoperatively, every case were continuously received intermittent pneumatic compression for 14 to 21 days (2 hours, qid), and venography were performed on the operated lower limb on the 7th day after operation to check the presence of deep venous thrombosis. RESULTS: Among the 40 cases, there were 4 cases of deep venous thrombosis without symptom of pulmonary embolism, the incidence rate was 10%. CONCLUSION: Intermittent pneumatic compression can significantly reduce the incidence rate of deep venous thrombosis after the operation of the lower limbs.
Objective To systematically assess the therapeutic effect of rivaroxaban and enoxaparin on preventing deep venous thrombosis after major orthopedic operation. Methods Such databases as MEDLINE, EMbase, The Cochrane Library (Issue 3, 2009), Current Controlled Trials, The National Research Register, CBM, and CNKI were searched from their establishment to December 2009 in whatever language. Related journals were handsearched as well. Randomized controlled trials (RCTs) of comparing therapeutic effects of rivaroxaban and enoxaparin on preventing deep venous thrombosis after major orthopedic operation were included. Data were extracted and their quality was evaluated, and meta-analyses were conducted by using RevMan 5.0.25 software. Results Seven RCTs with 15 458 patients were included. The results of meta-analyses showed that compared with enoxaparin, rivaroxaban reduced the end risk of the primary efficacy to 60% (RR=0.40, 95%CI 0.28 to 0.57, Plt;0.000 01) and reduced the end risk of the main secondary efficacy to 71% (RR=0.29, 95%CI 0.15 to 0.56, Plt;0.000 01), and the end risk of other efficacy to 56% (RR=0.44, 95%CI 0.29 to 0.66, Plt;0.000 01). During the treatment, rivaroxaban and enoxaparin displayed similarity in terms of the incidence of serious bleeding events (RR=1.16, 95%CI 0.68 to 1.999, P=0.59) and the secondary safety endpoint. Conclusion Rivaroxaban is effective in preventing deep venous thrombosis after major orthopedic operation and can significantly reduce the risk of postoperative deep vein thrombosis.
Objective To evaluate the safety and efficacy of intermittent pneumatic compression in prevention of deep venous thrombosis after major orthopedic operation. Methods We searched MEDLINE (1966 to January 2008), The Cochrane Library (Issue 2, 2008), CBM (1996 to January 2008), CNKI (1998 to January 2008), VIP (1998 to January 2008), and retrieved clinical controlled trials (CCTs) or randomized controlled trials (RCTs) in which IPC was used as an intervention to prevent DVT, and all the trials were published in English or Chinese. The methodological quality of the included studies was assessed according to the standard of Cochrane systematic review. RevMan 4.2 software was used for meta-analysis. Results Seven RCTs and 1 CCT were included. Their methodological quality was poor. The results of Meta–analyses showed: (1) The incidence of DVT in the IPC group was lower than that in the control group (RR=0.20, 95%CI 0.11 to 0.35, Plt;0.000 01); (2) There was no difference in the incidence of DVT between the IPC group and the LMWH group (RR=0.70, 95%CI 0.28 to 1.74, P=0.44); (3) The incidence of DVT in the IPC plus LMWH group was lower than that in the LMWH-alone group (RR=0.23, 95%CI 0.10 to 0.52, P=0.000 4). Furthermore, the incidence of DVT in the IPC plus LMWH group was lower than that in the GCS plus LMWH group (Plt;0.000 1). No severe adverse reaction of IPC in DVT prevention was reported. Conclusion IPC shows an effective tendency in DVT prevention, but because of the low quality and the small sample of the included studies, this conclusion needs to be verified by protocols of more samples and high quality.
Objective To evaluate the effectiveness and safety of surgical thrombectomy for acute deep venous thrombosis of lower extremities. Methods Randomized controlled trials of surgery versus conservative treatment were sought from MEDLINE (1966-Jun.2006), EMbase (1974-Jun.2006), The Cochrane Library (Issue 2, 2006), CBM (1989-Jun. 2006) and CMCC (1994-Jun. 2006). Collections of Chinese Congress on Vascular Surgery (1991-Jun.2006) and the journal of Vascular Surgery (2000-Jun. 2006) were handsearched. Two reviewers independently extracted data into a designed extraction form. The guidance in The Cochrane Collaboration’s Handbook was consulted for quality evaluation and data analysis. Results Six potentially eligible studies were identified. Six were included according to the inclusion criteria. The 6-month total patency was significantly higher in the surgical treatment group than in the conservative treatment group with OR 7.26 and 95%CI 2.40 to 21.94, while the 5-year total patency was not different between the two groups with OR 2.59 and 95%CI 0.88 to 7.67. At month 6 and year 5, the incidence of post-thrombosis syndrome (PTS) was significantly higher in the conservative treatment group than in the surgical treatment group with OR 0.11, 95%CI 0.59 to 1.59, OR0.18, 95%CI 0.06 to 0.60 respectively. The incidence of 10-year PTS and the results of valvular function measurements were similar between the two groups. The incidence of pulmonary thrombosis was also comparable between the two groups with OR 1.40 and 95%CI 0.39 to 4.97. Conclusion Surgical thrombectomy may improve the extent of patency and venous valvular sufficiency in the short term, but without increasing the patency rate. There is no enough evidence to assess whether surgical throbectomy improves long-term outcomes. It is safe to preform surgical thrombectomy. The small number of patients randomised and the low quality of the trials decreases the reliability of the current evidence. Therefore, more high quality randomised controlled studies should be done, to determine the long-term outcomes of surgical thrombectomy.