ObjectivesTo systematically review the efficacy and safety of direct oral anticoagulants (DOAC) on preventing venous thromboembolism (VTE) after major orthopedic surgery (MOS).MethodsThe Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and CBM databases were electronically searched for randomized controlled trials (RCTs) on the efficacy and safety of DOAC on preventing VTE after MOS from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 22 RCTs involving 41 244 patients were included. The results of meta-analysis showed that: the rate of symptomatic deep vein thrombosis (DVT) after MOS in rivaroxaban (Peto OR=0.54, 95%CI 0.35 to 0.82, P=0.004) and apixaban (Peto OR=0.49, 95%CI 0.26 to 0.92, P=0.03) were lower than enoxaparin. Additionally, the rate of symptomatic pulmonary embolism (PE) after MOS in rivaroxaban was lower than enoxaparin (Peto OR=0.53, 95%CI 0.29 to 0.96, P=0.04), however, in major bleeding after MOS rivaroxaban was significant higher than enoxaparin (Peto OR=1.98, 95%CI 1.30 to 3.01, P=0.001).ConclusionsCurrent evidence shows that rivaroxaban and apixaban is superior to enoxaparin on preventing symptomatic DVT after MOS. Rivaroxaban is superior to enoxaparin on preventing symptomatic PE, however, the risk of major bleeding is higher than enoxaparin. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
Objective To investigate the incidence and management of CTEPH in the Department of Pulmonary and Critical Care Medicine in Xijing Hospital to enrich the epidemiological data of chronic thromboembolic pulmonary hypertension (CTEPH) in China.Methods We conducted a retrospective study to investigate the incidence and management of CTEPH in the Department of Pulmonary and Critical Care Medicine in Xijing Hospital from 2008 to 2012. Results The incidence of CTEPH was 5.24% . About 62.90% of venous thromboembolism/pulmonary embolism (VTE/PE) patients were unprovoked, and about 53.85% of CTEPH patients was unprovoked. About 38% of CTEPH patients had no history of VTE, and 62% of CTEPH patients had no history of acute pulmonary embolism. None of the CTEPH patients was treated by pulmonary thromboendarterctom (PTE) , and about 53.85% of patients were only given anticoagulant monotherapy. Conclusions The incidence of CTEPH is higher in our hospital than reported. This phenomenon may be related to the lack of awareness of risk factors of CTEPH and the insufficient thrombolytic and anticoagulant therapy to acute pulmonary embolism. It’s very urgent to standardize the diagnosis and management of CTEPH in pulmonologists.
Objective To explore the correlation between risk factors in respiratory department patients and the occurrence of venous thromboembolism (VTE), and to evaluate the optimization of the Padua score for predicting VTE occurrence in hospitalized respiratory patients based on these correlations. The effectiveness of the modified assessment model for VTE prediction was also validated. Methods A retrospective study was conducted, involving 51 VTE patients who were hospitalized in the Respiratory Department of Huaian First People’s Hospital from March 2019 to July 2023. These patients were compared with 1,600 non-VTE patients who were discharged during the same period. Clinical data, including medical history and laboratory test results, were retrospectively collected from both groups. The correlation between clinical data and VTE occurrence was analyzed, and highly relevant risk factors were incorporated into the Padua score. The modified Padua risk assessment model was applied to all patients and validated in a validation group. The scores from both the original and modified risk assessment models were compared to evaluate the effectiveness of the modified Padua score. Results Rank sum tests showed significant differences in basic information, such as age, BMI, and length of hospital stay, as well as laboratory tests including mean corpuscular volume, procalcitonin, albumin, alanine aminotransferase, aspartate aminotransferase, urea, and D-dimer (P<0.05). Univariate and multivariate logistic regression analyses revealed that newly identified high-risk factors for VTE included hypoalbuminemia (OR=2.972), blood transfusion (OR=47.035), and mechanical ventilation (OR=6.782) (P<0.05). Receiver operating characteristic curve analysis showed that the sensitivity and specificity of the modified Padua score were higher than those of the original version. The area under the curve (AUC) difference was 0.058, with a Z-test value of 2.442, showing statistical significance (P<0.05). Conclusions The modified Padua score demonstrated superior predictive ability for VTE in hospitalized respiratory patients compared to the original Padua score.
Objective To investigate the value of fibrinogen to albumin ratio (FAR) combined with pulmonary embolism severity index (PESI) in the assessment of severity and prognosis of patients with acute pulmonary thromboembolism (APTE). Methods A retrospective study of hospitalized patients with confirmed APTE admitted to the Affiliated Hospital of Southwest Medical University from September 2013 to August 2021, divided into low-risk, intermediate-risk, and high-risk groups according to the Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism, and divided into survival groups and death groups according to the 30-day prognosis. The general data of all patients and relevant blood laboratory tests within 2 hours after admission were collected to calculate PESI and FAR. FAR and PESI levels were compared in APTE patients with different severity of disease and different prognosis. Independent risk factors for 30-day mortality in APTE patients were analyzed using logistic regression. Subject working characteristic curves were drawn to assess the differences in sensitivity, specificity and area under the curve of FAR, PESI and FAR combined with PESI in predicting 30-day death. Results Total of 235 APTE patients were included, divided into 85 in the low-risk group, 110 in the intermediate-risk group, and 40 in the high-risk group; 192 in the survival group and 43 in the death group according to 30-day survival. The differences in age, albumin (ALB), high-sensitivity troponin, D-dimer, fibrinogen (FIB), FAR, and PESI of APTE patients with different disease severity were statistically significant (P<0.05). FAR increased progressively with increasing severity of disease (P<0.05), and correlation analysis showed a positive correlation between FAR and PESI (r=0.614, P<0.05). Elevated FIB, FAR, PESI and decreased ALB were independent risk factors for 30-day death in patients with APTE (P<0.05). FAR, PESI, and FAR combined with PESI all had predictive value for 30-day death in APTE patients, and FAR combined with PESI predicted the largest area under the 30-day death curve. Conclusions FAR correlated with the severity and prognosis of APTE patients. FAR combined with PESI was more valuable in assessing the 30-day prognosis of APTE patients than FAR alone or PESI alone.
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.
The incidence of venous thromboembolism (VTE) is relatively high in the elderly population, and the disability, mortality, and medical expenses caused by VTE are also high. However, in a large number of randomized controlled and non-randomized controlled studies related to VTE, sufficient attention has not been paid to the elderly population with multiple underlying diseases. Therefore, the vast majority of research results recommended by VTE guidelines come from younger patients and healthy elderly people, at the same time, most relevant VTE prevention and treatment guidelines or consensus are formulated for hospitalized patients, and for non-hospital elderly populations such as home and elderly care institutions that truly need attention and risk of VTE, their recommended opinions are uncertain. In this context, the Peripheral Vascular Disease Management Branch of the Chinese Geriatrics Society has developed a consensus among Chinese experts on the prevention and treatment of VET in the elderly, based on evidence-based evidence such as domestic and foreign guidelines and relevant research.
ObjectiveTo explore the clinical application value of antithrombin Ⅲ (ATⅢ) in pulmonary thromboembolism (PTE).MethodsA retrospective study included 204 patients with confirmed PTE who were admitted to Fujian Provincial Hospital from May 2012 to June 2019. The clinical data of the study included basic conditions, morbilities, laboratory examinations and scoring system within 24 hours after admission. The relationship between ATⅢ and PTE in-hospital death was analyzed, and the value of ATⅢ to optimize risk stratification was explored.ResultsFor ATⅢ, the area under receiver operating characteristic curve (AUC) of predicting in-hospital mortality was 0.719, with a cut-off value of 77.7% (sensitivity 64.71%, specificity 80.21%). The patients were divided into ATⅢ≤77.7% group (n=48) and ATⅢ>77.7% group (n=156) according to the cut-off value, and significant statistically differences were found in chronic heart failure, white blood cells count, platelets count, alanine aminotransferase (ALT), albumin and troponin I (P<0.05). According to the in-hospital mortality, patients were divided into a death group (n=17) and a survival group (n=187), and the differences in count of white blood cells, ATⅢ, D-dimer, ALT, albumin, estimated glomerular filtration rate and APACHEⅡ were statistically significant. Logistic regression analysis revealed that ATⅢ≤77.7% and white blood cells count were independent risk factors for in-hospital death. The risk stratification and the risk stratification combined ATⅢ to predict in-hospital death were evaluated by receiver operating characteristic curve, and the AUC was 0.705 and 0.813, respectively (P<0.05). A new scoring model of risk stratification combined with ATⅢ was showed by nomogram.ConclusionsATⅢ≤77.7% is an independent risk factor for in-hospital death, and is beneficial to optimize risk stratification. The mechanism may be related to thrombosis, right ventricular dysfunction and inflammatory response.
Objective To invesitgate the prevalence of pulmonary thromboembolism （PTE） in hospitalized patients with obstructive sleep apnea-hypopnea syndrome （OSAHS）from January 2004 to December 2008，and analyse its impact on the severity of OSAHS. Methods Demographic and clinical characteristics of 24 OSAHS patients complicated with PTE were analyzed. 30 OSAHS patients without PTE were served as controls. Results PTE was detected in 2.44% （31/1268） of the OSAHS patients. When compared with the OSAHS patients without PTE，the OSAHS patients with PTE had a significantly higher apnea hypopnea index （AHI） [（27.8±11.6）/h vs. （18.2±8.1）/h，P=0.038] and a lower LSpO2 （lowest saturated pulse arterial oxygen level） [（78.4±8.5）% vs. （85.2±7.9）%，P=0.035]. Both groups received continuous positive airway pressure （CPAP） ventilation. Anticoagulation and/or thrombolysis treatment were used in the OSAHS patients with PTE. Conclusions We found a higher prevalence of PTE in patients with OSAHS. Compared with those without PTE，OSAHS patients with PTE have more severe sleep apnea-hypopnea and hypoxemia in sleep. Comprehensive treatments including anticoagulation and CPAP should be used in these patients.
As technology advances, current evidence supports the use of devices for valvular heart disease interventions, including transcatheter aortic valve implantation, transcatheter mitral or tricuspid valve repair, and transcatheter mitral valve implantation. These procedures require antithrombotic therapy to prevent thromboembolic events during the perioperative period, and these therapies are associated with an increased risk of bleeding complications. To date, there are challenges and controversies regarding how to balance the risk of thrombosis and bleeding in these patients, and therefore the optimal antithrombotic regimen remains unclear. In this review, we summarize the current evidence for antithrombotic therapy after transcatheter intervention in patients with valvular heart disease and highlight the importance of an individualized approach in targeting these patients.
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.