Objective
To explore the relationship between thrombocytosis and all-cause in-hospital mortality in patients with chronic obstructive pulmonary disease (COPD) and low-risk pulmonary embolism (PE).
Methods
In a multicenter retrospective study on clinical characteristics, COPD patients with proven acute PE between October 2005 and February 2017 were enrolled. The patients in risk classes III-V on the basis of the PESI score were excluded. The patients with COPD and low-risk PE were divided into two groups of those with thrombocytosis and without thrombocytosis after extracting platelet count on admission. The clinical characteristics and prognosis of the two groups were compared. Multivariate logistic regression was performed to reveal an association between thrombocytosis and all-cause in-hospital mortality after confounding variables were adjusted.
Results
A total of 874 consecutive patients with COPD and PE at low risk were enrolled in which 191 (21.9%) with thrombocytosis. Compared with those without thrombocytosis, the thrombocytopenic group had significantly lower body mass index [(20.9±3.3) kg/m2 vs. (25.1±3.8) kg/m2, P=0.01], lower levels of forced expiratory volume in one second (FEV1) [(0.9±0.4) L vs. (1.3±0.3) L, P=0.001] and lower partial pressure of oxygen in the arterial blood (PaO2) [(7.8±1.2) kPa vs. (9.7±2.3) kPa, P=0.003]. The COPD patients with thrombocytosis had a higher proportion of cardiovascular complications as well as higher level of systolic pulmonary arterial pressure (sPAP) [(46.5±20.6) mm Hg vs. (34.1±12.6) mm Hg, P=0.001]. Multivariate logistic regression analysis after adjustment for confounders revealed that thrombocytosis was associated with all-cause mortality in hospitalized patients with COPD and low-risk PE (adjusted OR=1.53, 95%CI 1.03–2.29), and oral antiplatelet treatment was a protective factor (adjusted OR=0.71, 95%CI 0.31–0.84).
Conclusions
Thrombocytosis is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk. Antiplatelet therapy may play a protective role in the high-risk cohort.
ObjectivesTo compare the efficacy of acute physiology and chronic health evaluationⅡ (APACHEⅡ), national early warning score (NEWS), pulmonary embolism severity index (PESI) and Charlson comorbidity index (CCI) on pulmonary embolism (PE) prognosis.MethodsClinical data of patients with PE treated in The Second Xiangya Hospital of Central South University from 2010 to 2017 were retrospectively analyzed. They were divided into death group and survival group, and four clinical scores were calculated. The differences of risk factors between the two groups were compared. Logistic regression analysis was used to obtain the independent risk factors related to mortality. The ROC working curve was used to compare the capability of four clinical scores for PE mortality. SPSS 24.0 and Medcalc 18.2.1 software were used for statistical analysis. ResultsA total of 318 patients with PE were included, and the mortality rate was 13.2%. The APACHEⅡ, NEWS, PESI and CCI of the death group were higher than those of the survival group. There were significant differences between two groups (P<0.05). It was confirmed by logistic regression analysis that cerebrovascular disease, heart rate, leukocyte, troponin T, arterial partial pressure of oxygen, right ventricular dysfunction (RVD) were independent risk factors for 90-day mortality. The areas under the ROC curve of APACHEⅡ, CCI, PESI, NEWS were 0.886, 0.728, 0.715 and 0.731, respectively. The area under the ROC curve of APACHEⅡ was the largest, which was better than NEWS, CCI and PESI (P<0.05), and there was no significant difference among NEWS, CCI and PESI.ConclusionsAPACHEⅡ may be the best predictor of mortality in PE patients, which is superior to NEWS, CCI and PESI.
ObjectivesTo evaluate the effects of Pulmonary Embolism Response Team (PERT) on treatment strategies and long-term prognosis in patients with acute pulmonary embolism before and after the implementation of the first PERT in China. Methods The official start of PERT (July 2017) was took as the cut-off point, all APE patients who attended Beijing Anzhen Hospital of Capital Medical University one year before and after this cut-off time were included through the hospital electronic medical record system. The APE patients who received traditional treatment from July 5, 2016 to July 4, 2017 were recruited in the control group (Pre-PERT group), and the APE patients who received PERT mode treatment from July 5, 2017 to July 4, 2018 were recruited as the intervention group (Post-PERT group). Treatment methods during hospitalization were compared between the two groups. The patients were followed up for one year after discharge to evaluate their anticoagulant therapy, follow-up compliance and long-term prognosis. Results A total of 108 cases in the Pre-PERT group and 102 cases in the Post-PERT group were included. There was no significant statistical difference between the two groups in age and gender (both P>0.05). Anticoagulation therapy (87.3% vs. 81.5%, P=0.251), catheter-directed treatment (3.9% vs. 2.8%, P=0.644), inferior vena cava filters (1.0% vs. 1.9%, P=1.000), surgical embolectomy (2.0% vs. 0.9%, P=0.613), systemic thrombolysis (3.9% vs. 4.6%, P=0.582) were performed in both groups with no significant differences between the two groups. The use rate of rivaroxaban in the Post-PERT group was higher than that in the Pre-PERT group at one year of discharge, and the use rate of warfarin was lower than that of the Pre-PERT group (54.5% vs. 32.5%; 43.6% vs. 59.0%, P=0.043). The anticoagulation time of the Post-PERT group was longer than that of the Pre-PERT group (11.9 months vs. 10.3 months, P<0.001). The all-cause mortality within one year, hemorrhagic events and the rate of rehospitalization due to pulmonary embolism were not significantly different between the two groups, (10.4% vs. 8.6%), (14.3% vs. 14.8%), and (1.3% vs. 2.5%, χ2=3.453, P=0.485), respectively. Conclusions APE treatment was still dominated by anticoagulation and conventional treatment at the early stage of PERT implementation, and advanced treatment (catheter-directed treatment and surgical embolectomy) is improved, it showed an expanding trend after only one year of implementation although there was no statistical difference. At follow-up, there is no increase in one-year all-cause mortality and bleeding events with a slight increase in advanced treatment after PERT implementation.
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.
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 improve the knowledge of paradoxical embolism originated from pulmonary embolism. Methods The medical literature about pulmonary embolism complicated with paradoxical embolism from 1998 to 2011 was searched from “Wanfang medical literature database”. Meanwhile 1 case diagnosed in Central Hospital of Dazhou City was reported. Then the clinical characteristics were summarized. Results 51 cases of pulmonary embolism complicated with paradoxical embolism were diagnosed, aged from23 to 76 years old. There were 27 males and 23 females, and sex was unknown in 1 case. In all cases, the cerebral embolism occurred in 30 cases( 58. 8% ) , lower limb artery embolism in 14 cases( 27. 4% ) , kidney artery embolism in 6 cases( 11. 8% ) , patent foramen ovale with straddling thrombus in 4 cases( 8% ) ,multiple embolismin 8 cases( 15. 7% ) , heart ventricle with straddling thrombus in 1 case ( 1. 96% ) , coronary artery embolism in 1 case( 1. 96% ) , aorta embolism in 1 case( 1. 96% ) , and spleen embolism in 1 case ( 1. 96% ) . There were 35 patients ( 68. 8% ) with patent foramen ovale and 7 cases ( 13. 7% ) died. Conclusions Paradoxical embolism waranted more awareness in the cases of pulmonary embolismand/ or venous thromboembolism and aggressive screening might avoid misdiagnosis.
【摘要】 目的 觀察經皮導管介入治療急性肺栓塞的療效。 方法 選擇2003年1月-2009年6月收治的急性肺栓塞患者15例，采用經皮導管吸栓術、碎栓術及溶栓術治療。溶栓術用局部灌注加即刻靜脈注射尿激酶，總量100萬U。溶栓后給予低分子肝素7~10 d，口服華法林3~6個月。觀察臨床癥狀、體征改善情況、并發癥、平均肺動脈壓（mPAP）與動脈血氧分壓（PO2）的變化，以及肺動脈開通情況。 結果 12例肺動脈完全開通，3例部分開通，顯效率89%，有效率100%。mPAP從（41.07±6.97） mm Hg降到（21.00±5.66） mm Hg，PO2從（46.26±9.30） mm Hg升到（79.49±8.04） mm Hg，治療前后差異有統計學意義（Plt;0.05）。即刻臨床癥狀明顯改善，mPAP迅速降低11例。隨訪3~6個月，療效持續，未見復發。 結論 介入治療急性肺栓塞療效顯著，安全可行，對搶救危重患者、改善臨床癥狀、維持血流動力學穩定有重要作用。【Abstract】 Objective To observe the clinical curative effect on acute pulmonary embolism(PE)via percutaneous catheter intervention. Methods Fifteen acute PE patients admitted from January 2003 to June 2009 were treated with percutaneous catheter drawing of thrombus, thrombectomy, and thrombolysis. Local infusion and immediate intra-venous injection of urokinase with 100 000 000 U in total were used for thrombolysis. Afterwards, the low molecular weight heparin was given for seven to ten days, and an oral intake of warfarin lasts for three to six months. Observe the clinical symptoms, improvement of physical signs, occurrence of complications, change of mean pulmonary arterial pressure (mPAP) and arterial partial pressure of oxygen (PO2), as well as the patency condition of pulmonary artery. Results Twelve of fifteer patients gained complete patency of pulmonary artery, and the other three patients gained partial patency, with an obvious effectiveness rate of 89% and an effectiveness rate of 100%. mPAP decreased from (41. 07±6. 97) mm Hg to (21. 00±5. 66) mm Hg, and PO2 elevated from (46. 26±9. 30) mm Hg to (79. 49±8. 04) mm Hg, showing a significant difference (Plt;0. 05) before and after the therapy. The immediate clinical symptoms exhibited a significant improvement. The pulmonary artery pressure of 11 patients dropped rapidly. During three to six months’ follow up, the therapeutic effects persisted and no recurrence was found. Conclusion The interventional treatment of acute PE demonstrates remarkable effectiveness, safety and feasibility, which plays an important role in the rescue of critical patients, improvement of clinical symptoms, and maintenance of hemodynamic stability.
