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.
ObjectiveTo summarize the clinical characteristics and the long-term results of pulmonary thromboendarterectomy (PTE) in the chronic thromboembolic pulmonary hypertension (CTEPH) patients with unilateral main pulmonary artery occlusion.MethodsWe retrospectively analyzed the clinical data of 15 CTEPH patients with unilateral main pulmonary artery occlusion in Fuwai Hospital between 2004 and 2018. There were 11 males and 4 females aged 34.1±12.0 years at operation.ResultsThe mean circulatory arrest was 31.1±12.1 minutes. The ICU stay was 5 (2-29) d. The hospital stay was 15 (8-29) d. There was no hospital death. There was a decline in systolic pulmonary artery pressures (sPAP, 69.9±27.9 mm Hg to 35.1±9.7 mm Hg, P=0.020) after surgery. On postoperative V/Q scan, only 6 patients (40.0%) had significant improvement in reperfusion (≥75% estimated) of the occluded lung. There was no death during the median observation period of 49 months follow-up, while 2 patients had recurrence of pulmonary embolism.ConclusionCTEPH patients with unilateral main pulmonary artery occlusion represent a challenging cohort. PTE is a curative resolution in both early- and long- term results, although there is a high requirement of perioperative management and a high risk of postoperative complications and rethrombosis.
Objective To investigate the compliance status of intermittent pneumatic compression device (IPCD) in patients after lumbar surgery, and to analyze the reasons and influencing factors affecting compliance. Methods The continuous enrollment method was used to select patients who underwent posterior decompression for lumbar degenerative diseases in the orthopedic department of Peking Union Medical College Hospital between December 2022 and June 2023. The general information of patients and their compliance with IPCD were collected, and the reasons that affected compliance were analyzed. ResultsA total of 46 patients were included. The overall proportion of patients with good compliance was relatively low, and their compliance was poor. On the first and second day after surgery, the daytime compliance was relatively good (the proportion range of excellent compliance was 39%-52%); the compliance at night was significantly lower than that during the daytime (the proportion range of excellent compliance was 21%-26%); after 3 days of surgery, the patients’ compliance significantly decreased. A total of 460 time periods were observed and 195 reasons for not using IPCD were collected. The main reasons were physical discomfort caused by the device, inconvenience during bedside activities, and little significance to the patient. The compliance of female patients was better than that of males (P<0.05). Patients with education level of primary school and below had the highest compliance, while patients with high school and above had the lowest compliance (P<0.05). There was no statistically significant difference in compliance among patients of different age groups (P>0.05). Conclusions The overall compliance of patients with IPCD after lumbar surgery is poor, which is an urgent clinical problem, and the adaptability and cognitive level of patients to the device are the main factors affecting compliance. In clinical nursing work, men and patients with higher education level should be strengthened.
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.
Venous thromboembolism (VTE) is a high-risk complication in hospitalized patients, especially in patients with orthopedic surgery, neurosurgery, thoracic surgery, cardiac surgery and tumor surgery. It is also a significant cause of patients’ unexpected death and perioperative death. Through establishment of norms of VTE management system and organizational structure, formulation of perfect VTE risk assessment system and prevention and treatment scheme for hospitalized patients, training of all the medical staff for related knowledge, and test operation of the system in key departments, we established a hospital standardized system of venous thromboembolism prevention and management. Our VTE prevention and treatment work achieved good results through multidisciplinary collaboration.
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 analyze the risk factors and clinical characteristics of patients in Uyghur and Han nationalities with pulmonary thromboembolism (PTE), who were hospitalized in past 7 years in the First Affiliated Hospital of Xinjiang Medical University, so as to investigate differences of risk factors between two nationalities. Methods Through retrospective study, clinical characteristics of PTE patients hospitalized from 2004 to 2010 were analyzed. T-test and chi-square test were used to conduct statistic analysis. Results a) A total of 516 patients (mean age 58.7±14.8 years old) with complete clinical materials were included, of whom 360 were Han nationality (69.8%, mean age 63.5±15.5 years old) and 156 were Uyghur nationality (30.2%, mean age 52.8±14.3 years old). In Han nationality, the peak age of PTE onset was above 70 years of age, while in Uyghur nationality it was 60 to 69 years of age; b) No significant difference was found in the clinical characteristics between the two nationalities; and c) The commonly acquired risk factors for PET patients in both nationalities possibly were age at or over 40 years old, obesity, embolism history and hyperlipidemia. The main risk factor of PTE was obesity in Uyghur nationality, while that was smoking in Han nationality. Conclusion The most common acquired risk factors and basic diseases of PTE patients are probably the age at or over 40 years old, obesity, embolism history and hyperlipidemia, and obesity is commonly seen in Uyghur nationality. A large number of further case-control studies are needed to further confirm this conclusion.
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.