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.
Objective To investigate the risk factors and prevention methods of the venous thromboembolism (VTE) after hepatectomy. Methods The literatures about VTE after hepatectomy in recent years at home and abroad were reviewed and summarized. Results The risk factors for postoperative VTE include tumor, male, old age, massive hepatectomy, hypercoagulability, etc. The incidence of VTE in patients with massive hepatectomy is significantly higher, which is closely related to the hypercoagulability caused by postoperative liver dysfunction. Effective prophylaxis include mechanical methods and anticoagulant drugs, the latter of which can markedly reduce the incidence of VTE. For patients who develop postoperative liver insufficiency, including those with cirrhosis and high risk of bleeding, anticoagulant VTE prophylaxis dosing decisions should be made with caution. In addition, it is rationale for extended thromboprophylaxis in high risk patients. Conclusions VTE is a common complication after hepatectomy, resulting in prolonged postoperative hospital stay and increased postoperative mortality. Therefore, it is important to determine the risk of VTE after surgery to improve the prognosis of patients after hepatectomy.
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.
Objective To explore the causal association between obstructive sleep apnea (OSA) and venous thromboembolism (VTE). Methods Using the summary statistical data from the FinnGen biological sample library and IEU OpenGWAS database, the relationship between OSA and VTE, including deep vein thrombosis (DVT) and pulmonary embolism, was explored through Mendelian randomization (MR) method, with inverse variance weighted (IVW) as the main analysis method. Results The results of univariate MR analysis using IVW method showed that OSA was associated with VTE and pulmonary embolism (P<0.05), with odds ratios and 95% confidence intervals of 1.204 (1.067, 1.351) and 1.352 (1.179, 1.544), respectively. There was no correlation with DVT (P>0.05). Multivariate MR analysis showed that after adjustment for confounding factors (smoking, diabetes, obesity and cancer), OSA was associated with VTE, DVT and pulmonary embolism (P<0.05), with odds ratios and 95% confidence intervals of 1.168 (1.053, 1.322), 1.247 (1.064, 1.491) and 1.158 (1.021, 1.326), respectively. Conclusion OSA increases the risk of VTE, DVT, and pulmonary embolism.
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 summarize the present research progress of venous thromboembolism in the elderly. Methods Reviewed the literatures in recent years about the epidemiology, risk factors, diagnosis, prevention, and prognosis of venous thromboembolism in the elderly. Results Venous thromboembolism was a more common cardiovascular system diseases for the elderly, the incidence was higher, but the elderly didn’t pay much attention on it. The clinical manifestations of venous thromboembolism in elderly were different from young people, and all kinds of inspection methods had advantages and disadvantages. It gave priority to anticoagulation therapy, but we should pay attention to the risk of bleeding. Conclusions High incidence of venous thromboembolism was observed in the elderly, and diagnostic measures for venous thromboembolism were various. In the process of treatment, classification, the pros and cons were especially needed to pay attention to, and its special researches were necessary.
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.
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.
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.
Objective To examine the association between programmed cell death ligand 1 (PD-L1) expression and venous thromboembolism (VTE) risk in lung cancer patients treated with immune checkpoint inhibitors (ICIs). Methods We enrolled adults with lung cancer who initiated ICIs between January 2018 and March 2022 at West China Hospital of Sichuan University. The included patients were divided into PD-L1 TPS<50% group and PD-L1 TPS≥50% group. Clinical outcomes including VTE, pulmonary embolism (PE), and deep venous thrombosis (DVT) were evaluated with cox regression models. Results Of the 519 lung cancer patients receiving ICIs finnaly analyzed (347 cases with PD-L1 TPS<50%; 172 cases with PD-L1 TPS≥50%), VTE developed in 48 cases (9.2%) during the 12-month follow-up, of which 41 cases (7.9%) had DVT, 4 cases (0.8%) had PE, and 3 cases (0.6%) had DVT and PE. A higher incidence of VTE was observed in TPS<50% group versus TPS≥50% group (P=0.026), whereas there was a trend toward an increased rate of DVT, which was not statistically significant (P=0.052). Significant differences in PE were not found (P=0.152). After multivariable adjustment, PD-L1 TPS<50%, ECOG PS≥2, chronic obstructive pulmonary disease, and VTE history were associated with an increased VTE risk (P<0.05). Conclusion VTE occurred in 9.2% of ICI-treated lung cancer patients. PD-L1 TPS<50% was associated with an increased risk of VTE, which should be identified, prevented and intervened early in clinical practice.