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 explore the thromboembolic events and mortality in patients with different types of severe pneumonia, and to analyze the related high-risk factors. Methods A total of 161 severe pneumonia patients who admitted in intensive care unit from January 2018 to February 2023 were included in the study. The patients were divided into a COVID-19 group (n=88) and a community-acquired pneumonia (CAP) group (n=73) according to the type of pneumonia, and divided into a thrombosis group and a non-thrombosis group according to the occurrence of thrombosis. The patients were followed-up until discharge or in-hospital death, registering the occurrence of thrombotic events. Results During the in-hospital stay, 32.9% of CAP and 36.4% of COVID-19 patients experienced thrombotic events (P>0.05). In CAP group all the events (including 24 paitents) were venous thromboses, while in COVID-19 group 31 patients were venous and 3 were arterial thromboses (2 were cerebral infarction, and 1 with myocardial infarction). There were statistically significant difference in gender, age, venous thromboembolism score (VTE score), activated partial thromboplastin time (APTT), and procalcitonin (PCT) between the TE group and the Non-TE group. Logistic regression analysis showed that thrombotic events was associated with sex, age and APTT; gender (female: OR=2.47, 95%CI 1.13 - 5.39, P<0.05) and age (OR=1.04, 95%CI 1.01 - 1.07, P<0.05) were positively associated with thrombotic events. During the in-hospital follow-up, 44.3% of CAP patients and 42.5% of COVID-19 patients died (P>0.05). Receiver operator characteristic (ROC) curve analysis showed that APACHEⅡ score was more accurate in predicting mortality of severe pneumonia, and the area under the ROC curve (AUC) was 0.77 (95%CI 0.70 - 0.84, sensitivity 74.3%, specificity 68.1%), the AUC of the VTE score was 0.61 (95%CI 0.53 - 0.70, Sensitivity 31.4%, specificity 81.7%); the AUC of the creatinine was 0.64 (95%CI 0.56 - 0.73, sensitivity 72.9%, specificity 51.2%). While the Kappa value for kidney disease was 0.409 (P<0.05) presenting moderate consistency. Conclusions The incidence of thromboembolic events and mortality are high in patients with different types of severe pneumonia. Thrombophilia was associated with sex, age, and APTT. APACHEⅡ score, VTE score, and creatinine value were independent risk factors for predicting death from severe pneumonia.
静脉血栓栓塞症( venous thromboembolism, VTE) 包括肺血栓栓塞( pulmonary embolism, PE) 、深静脉栓塞( deep venous thrombosis, DVT) 和游走性栓塞性浅静脉炎, 是肿瘤发展自然病程及抗肿瘤治疗过程中的常见并发症。流行病学资料表明肿瘤患者VTE 发生率比非肿瘤患者高2～4 倍[1] 。在各种肿瘤类型中, 肺癌并发VTE 几率较高, Blom等[2] 研究表明肺癌患者发生VTE 的风险比非肿瘤病人高20 倍。大约3% 的肺癌患者在肿瘤诊断后的1 年内发生VTE[3] 。
Objective To investigate the effect of rivaroxaban on the risk of bleeding after total knee arthroplasty (TKA). Methods A total of 119 cases undergoing primary TKA because of knee osteoarthritis between June 2009 and May 2011, were randomly divided into the rivaroxaban group (59 cases) and the control group (60 cases). There was no significant difference in gender, age, height, weight, side, disease duration, and grade of osteoarthritis between 2 groups (P gt; 0.05). Thepreoperative preparation and operative procedure of 2 groups were concordant. At 1-14 days after TKA, rivaroxaban 10 mg/d were taken orally in the rivaroxaban group, and placebo were given in the control group. The blood routine examination was performed before operation and at 2 days postoperatively; the total blood loss and hemoglobin (HGB) decrease were calculated according to the formula; the blood loss, postoperative wound drainage, and wound exudate after extubation were recorded to calculate the dominant amount of blood loss; and the bleeding events were recorded within 35 days postoperatively. Results The total blood loss and HGB decrease were (1 198.34 ± 222.06) mL and (33.29 ± 4.99) g/L in the rivaroxaban group and were (1 124.43 ± 261.01) mL and (31.57 ± 6.17) g/L in the control group, showing no significant difference (P gt; 0.05); the postoperative dominant blood loss in the rivaroxaban group [(456.22 ± 133.12) mL] was significantly higher than that in the control group [(354.53 ± 96.71) mL] (t=4.773, P=0.000). The bleeding events occurred in 3 cases (5.1%) of the rivaroxaban group and in 1 case (1.7%) of the control group, showing no significant difference (χ2=1.070, P=0.301). Conclusion Rivaroxaban has some effects on the risk of bleeding after TKA. In general, rivaroxaban is safe.
Objective To investigate the value of fibrinogen to albumin ratio (FAR) combined with pulmonary embolism severity index (PESI) in the assessment of severity and prognosis of patients with acute pulmonary thromboembolism (APTE). Methods A retrospective study of hospitalized patients with confirmed APTE admitted to the Affiliated Hospital of Southwest Medical University from September 2013 to August 2021, divided into low-risk, intermediate-risk, and high-risk groups according to the Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism, and divided into survival groups and death groups according to the 30-day prognosis. The general data of all patients and relevant blood laboratory tests within 2 hours after admission were collected to calculate PESI and FAR. FAR and PESI levels were compared in APTE patients with different severity of disease and different prognosis. Independent risk factors for 30-day mortality in APTE patients were analyzed using logistic regression. Subject working characteristic curves were drawn to assess the differences in sensitivity, specificity and area under the curve of FAR, PESI and FAR combined with PESI in predicting 30-day death. Results Total of 235 APTE patients were included, divided into 85 in the low-risk group, 110 in the intermediate-risk group, and 40 in the high-risk group; 192 in the survival group and 43 in the death group according to 30-day survival. The differences in age, albumin (ALB), high-sensitivity troponin, D-dimer, fibrinogen (FIB), FAR, and PESI of APTE patients with different disease severity were statistically significant (P<0.05). FAR increased progressively with increasing severity of disease (P<0.05), and correlation analysis showed a positive correlation between FAR and PESI (r=0.614, P<0.05). Elevated FIB, FAR, PESI and decreased ALB were independent risk factors for 30-day death in patients with APTE (P<0.05). FAR, PESI, and FAR combined with PESI all had predictive value for 30-day death in APTE patients, and FAR combined with PESI predicted the largest area under the 30-day death curve. Conclusions FAR correlated with the severity and prognosis of APTE patients. FAR combined with PESI was more valuable in assessing the 30-day prognosis of APTE patients than FAR alone or PESI alone.
ObjectiveTo summarize the clinical value of Caprini risk score (CRS) and D-dimer testing, both individually and in combination, for venous thromboembolism (VTE) risk stratification in patients undergoing laparoscopic surgery. MethodsThrough systematic literature review and analysis, we evaluated the advantages and limitations of these two tools in predicting VTE, with emphasis on their combined utility and respective detection characteristics. ResultsCRS demonstrated superior population stratification efficacy for initial VTE screening post-laparoscopy but showed limitations in assessing individual heterogeneity. D-dimer testing exhibited high sensitivity in detecting postoperative hypercoagulable states, yet its specificity was confounded by surgical stress-induced coagulation activation. Their integration established a multidimensional assessment system that significantly enhanced identification accuracy of high-risk VTE populations. ConclusionsThe combined application of CRS and D-dimer biomarkers optimizes postoperative VTE risk stratification management and provides evidence-based guidance for defining precise anticoagulation therapy timeframes. Future research should prioritize refinement of risk assessment tools to facilitate dynamic patient monitoring, thereby guiding targeted thromboprophylaxis and reducing occult VTE risk.
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.
Objective To investigate the relation of spinal ventricular septal angle (SVSA) measured by computer tomographic pulmonary angiography (CTPA) and pulmonary vascular resistance (PVR) measured by right heart catheterization in patients with chronic thromboembolic pulmonary hypertension (CTEPH) .Methods Eighty-nine patients with CTEPH (male 57, female 32; 53.08 ±12.43 years) were recruited as a CTEPH group, and 89 patients without pulmonary artery hypertension and pulmonary embolismwere recruited as a control group. The CTEPH patients received CTPA before right-heart catheterization and pulmonary angiography. SVSA and pulmonary artery obstruction indexes including Qanadli Index and Mastora index were evaluated by two radiologists.Results SVSA was 65.13°±12.26°and 39.69°±5.84°in the CTEPH group and the control group respectively, with significant difference between two groups ( t =14.479, P = 0.000) . Qanadli index of the CTEPH patients was( 42.50 ±17.67) % , which had no correlation with SVSA ( r= 0.094, P = 0.552) . Mastora index was ( 30.02 ±15.53) % , which also had no correlation with SVSA ( r=0.025, P =0.873) . SVSA had a moderate positive correlation with PVR ( r =0.529, P =0.000) and a weak positive correlation with right atriumpressure ( r =0.270, P =0.010) . Area under ROC was 0.764 and sensitivity, specificity for PVR≥1000 dyne· s· cm- 5 was 0.714 and 0.778 respectively when SVSA≥67.55°. Conclusion SVSA measured by CTPA can be used as a better predictor for evaluating PVR in CTEPH patients.
Objective Pulmonary thromboembolism ( PTE) is associated with various risk factors which existed in multidisciplinary patients. It is necessary to know what the role of pulmonologists in the diagnosis of PTE. Methods Data were collected from thirteen general hospitals in Guangxi. Hospital records of PTE cases from1995 to 2007 were retrospectively analyzed. The rates of PTE to inpatients between the respiratory departments and other departments or between different periods were compared. Results The rates of PTE of inpatients in respiratory departments ( 1. 55‰, 170/109 577) was higher than that in other departments ( 0. 03‰, 69/2 322 944) , P lt; 0. 001. Compared to that of 1995-2001, the rate of PTE of inpatients in the respiratory departments in the last 6 years increased by 3220. 22% [ ( 2. 43‰,167/68 638) vs ( 0. 07‰, 3 /40 939) ] . During 1995-2001 and 2002-2007, the rates of PTE of inpatients in the respiratory departments were higher than those in other departments [ 0. 004‰ ( 4/1 012 830) during 1995-2001 and 0. 05‰( 65 /1 310 114) during 2002-2007, respectively] , P lt; 0. 01. Conclusion pulmonologists play an important role in the diagnosis of PTE in the recent years.