ObjectivesTo systematically review the efficacy and safety of new oral anticoagulants (NOACs) for cancer-associated venous thromboembolism.MethodsStudies about the efficacy and safety of NOACs versus low molecular weight heparins (LMWHs) or vitamin K antagonists (VKAs) for cancer-associated venous thromboembolism were collected by searching PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases from inception to August, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsA total of 8 studies involving 2 448 patients were included. The results of meta-analysis showed that: there was no significant difference in the recurrent VTE rate (OR=0.74, 95%CI 0.49 to 1.11, P=0.15) or bleeding rate (OR=0.80, 95%CI 0.57 to 1.13, P=0.21) between NOACs group and VKAs group. The major bleeding rate was significantly higher in the VKAs group than in the NOACs group (OR=0.47, 95%CI 0.27 to 0.84, P=0.01). The incidences of recurrent VTE (OR=0.84, 95%CI 0.16 to 4.14, P=0.83), bleeding (OR=0.46, 95%CI 0.18 to 1.20, P=0.11), major bleeding (OR=0.45, 95%CI 0.12 to 1.60, P=0.21) were similar between NOACs group and LMWHs group.ConclusionsThe current evidence indicates that for cancer patients with VTE, NOACs are superior to warfarin and comparable to LMWHs. Due to limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.
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 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 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.
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.
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.
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 analyze the risk factors of venous thromboembolism (VTE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and to provide a theoretical basis for the prevention and treatment of AECOPD combined with VTE.MethodsA total of 413 AECOPD patients admitted to Pulmonary Department of Pulmonary Hospital and our hospital from February 2014 to September 2017 were selected as the study subjects. The patients of AECOPD with VTE were determined by the results of lower extremity venous ultrasound and CT pulmonary angiography. The incidence of AECOPD patients with VTE was calculated. Patients with AECOPD with VTE were assigned to the VTE group and AECOPD without VTE to non-VTE group. All the patient's gender, age and other general information, lower extremity pain swelling, walking difficulties, fever and other clinical symptoms, bed rest, hormone use, diuretic use of treatment information, laboratory tests and other indicators were collected. SPSS 20.0 was used for statistical analysis. T-test or rank sum test was used to compare between groups. Chi-square test was used to count data, and the results of univariate analysis were included in logistic regression analysis to analyze the risk factors of VTE in patients with AECOPD.ResultsThe incidence of VTE in patients with AECOPD was 12.59%. Increasing heart rate, pulmonary infarction "triple symptoms" the proportion of PTE patients with higher than the number of patients with deep vein thrombosis (DVT), the difference was statistically significant (P<0.05). PaO2, PaCO2, SpO2, and FEV1%pred in PTE patients of PTE were lower than those in DVT patients, pulmonary artery systolic pressure was higher than DVT patients, the difference was statistically significant (P<0.05). History of venous thrombosis (OR=1.986, P=0.031), lower extremity pain (OR=7.376, P=0.019), bed-staying duration≥3 d (OR=3.325, P=0.001) and D-dimer increase (OR=9.628, P=0.000) were independent risk factors for VTE in AECOPD patients.ConclusionsThe incidence of AECOPD patients with VTE is high, which needs to be paid attention. Observation should be enhanced for those AECOPD patients with risk factors such as history of venous thrombosis, lower extremity pain, bed-staying duration≥3 d and D-dimer increase in clinical work. If possible, imaging studies should be carried out as soon as possible to make early diagnosis.
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.
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
