ObjectiveTo explore the causal association between venous thromboembolism (VTE) and cardiovascular disease (CVD) risks using a two-sample bidirectional Mendelian randomization (MR) study. MethodsThe single-nucleotide polymorphism (SNP) data associated with VTE and CVD from genome-wide association studies were obtained as instrumental variables. Inverse variance weighted (IVW) was used as the main MR method and other methods were used as supplementary methods. Cochran's Q test, the intercept term of MR-Egger, and MR-PRESSO were used to assess pleiotropy and heterogeneity to ensure the robustness of the results. ResultsThe IVW method suggested a causal association between VTE and atrial fibrillation (OR=1.033, 95%CI 1.009 to 1.058, P=0.008), but no association was identified between VTE and coronary artery disease (OR=0.994, 95%CI 0.974 to 1.023, P = 0.551), heart failure (OR=1.021, 95%CI 0.992 to 1.050, P=0.159) and myocardial infarction (OR=1.012, 95%CI 0.971 to 1.055, P=0.568). The results of Cochran's Q test showed that there was no heterogeneity in the MR analyses of VTE and CVD. The MR-Egger intercept analysis and the MR-PRESSO global testing did not detect potential horizontal pleiotropy, and the results were robust. Reverse MR analysis was used to verify the presence of reverse causal associations. The reverse MR analysis demonstrated that reverse causal associations between VTE and CVD were not evidenced. ConclusionThe results of the MR study demonstrated a causal association between VTE and atrial fibrillation, but not with coronary artery disease, heart failure or myocardial infarction.
Objective To compare the efficacy of reteplase and ateplase in the treatment of acute massive pulmonary thromboembolism ( PTE) in emergency. Methods From January 2005 to December 2009,42 patients with acute massive PTE were treated by intravenous thrombolysis with reteplase or ateplase. The thrombolysis efficacy, bleeding incidence and mortality were measured. Results In the reteplase group, the emergency thrombolysis effective rate was 88. 9% among 18 patients. Mild bleeding occurred in 3 patients,moderate bleeding in 1 patient, and 2 cases died in hospital. In the ateplase group, the emergency thrombolysis effective rate was 75% among 24 patients. Mild bleeding occurred in 3 patients, moderate bleeding in 2 patients, and 3 cases died in hospital. The thrombolysis effective rate, bleeding incidence and mortality had no significant difference between the two groups. Conclusion Both the reteplase and ateplase thrombolysis therapy are safe and effective in the treatment of acute massive PTE, but reteplase thrombolysis therapy is more convenient in emergency.
Objective To study the related risk factors for recurrence of venous thromboembolism （VTE）. Methods The literatures about the related factors for recurrence of VTE were searched. The relationships between the factors and recurrence of VTE were determined by meta-analysis. Results A total of 12 literatures were included. The results of meta-analysis showed that factors such as males， age＜50 years old， malignant tumor， and antiphospholipid syndrome related with the recurrence of the first VTE after treatment， but there were no correlation between the recurrence of VTE， the type of first VTE， and causes of VTE. Conclusions The recurrence of VTE correlate with various factors. In order to avoid the recurrence of VTE， the patients with the risk factors for recurrence of VTE should be appropriate to extend the duration of anticoagulation
Objective To compare the clinical efficacy and safety of thrombolysis with anticoagulation therapy for patients with acute sub-massive pulmonary thromboembolism. Methods The clinical data of 84 patients with acute sub-massive pulmonary thromboembolism were analyzed retrospectively, mainly focusing on the in-hospital efficacy and safety of thrombolysis and/ or anticoagulation. The efficacy was evaluated based on 6 grades: cured, markedly improved, improved, not changed, deteriorated and died. Results Among the 84 patients,49 patients received thrombolysis and sequential anticoagulation therapy( thrombolysis group) , 35 patients received anticoagulation therapy alone( anticoagulation group) . As compared with the anticoagulation group, the thrombolysis group had higher effective rate( defined as patients who were cured, markedly improved or improved, 81. 6% versus 54. 3%, P = 0. 007) , lower critical event occurrence ( defined as clinical condition deteriorated or died, 2. 0% versus 14. 3% , P = 0. 032) . There was no significant difference in bleeding rates between the two groups ( thrombolysis group 20. 4% versus anticoagulation group 14. 3% , P gt; 0. 05) . No major bleeding or intracranial hemorrhage occurred in any of the patients. Conclusions Thrombolysis therapy may be more effective than anticoagulation therapy alone in patients with acute sub-massive pulmonary thromboembolism, and thus warrants further prospective randomized control study in large population.
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.
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 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 systematically review venous thromboembolism (VTE) risk assessment tools. Methods The Embase, PubMed, CNKI, CBM, WanFang Data, VIP databases and 22 relevant institutions and associations were searched to identify all VTE assessment tools from inception to December 31, 2022. Two researchers independently screened the literature, extracted data, and cross-checked the data. A qualitative analysis was used to describe the country's essential characteristics, publishing organization, year, applicable disease type, applicable population, tool formation method, etc. Key elements and techniques were compared in terms of evaluation dimension, methods, and procedures to form the tool, risk stratification ability, and whether to verify. Results A total of 42 VTE risk assessment tools were included, of which 16 were in the United States, and only 4 were in China. They were released between 1996 and 2021, and the applicable disease types and populations differ. Nineteen tools were constructed based on case-control or retrospective cohort studies, 16 were conducted using prospective cohort studies, and 5 were based on cross-sectional and RCT studies; Additionally, 20 tools were built based on logistic regression models; The evaluation dimensions of each tool differed, and the most common frequency of occurrences were VTE history, age, BMI value, and confirmed tumor, accounting for 64.29%, 54.76%, 54.76%, and 47.62%, respectively. Thirty-three tools were stratified for risk, and 30 tools were presented in the form of risk scores; Some tools lacked clinical validation data, and only 12 tools were analyzed for specificity, sensitivity, NPV, PPV, and AUC. Conclusion The evaluation dimensions and evidence sources of existing VTE risk assessment tools are not completely consistent, the implementation methods and results presentation forms of the tools are not completely the same, and the scope of application is different; Some tool construction methods and processes are not clear enough, and there is a lack of validation research on external validity, which has certain limitations in promoting clinical practice in China.
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 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.