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.
ObjectiveTo analyze the clinical characteristics of thrombo embolism (TE) in Chinese hypertrophic cardiomyopathy (HCM) patients. MethodsThis study retrospectively analyzed HCM patients admitted to West China Hospital of Sichuan University. The endpoints were defined as a composite of TE events, including ischemic stroke, transient ischemic attack, and peripheral arterial embolization. ResultsA total of 537 HCM patients were included with a median follow-up of 4.2 years. Forty-two patients reached the TE endpoint and the incidence was 1.9%. The annual incidence of TE was approximately 1.1% and 6.6% for HCM patients without/with atrial fibrillation, respectively. The recurrence rate of TE was high (approximately 26.2%). The mean age was 66.4±13.7 years for the first TE, and the incidence of TE was significantly increased at age ≥70 years. ConclusionThe incidence of TE is high in HCM patients, especially in those with atrial fibrillation, and the recurrence rate of TE is also high.
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.
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 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.
ObjectiveTo explore the predictive value of the maximum amplitude (MA) in the thromboelastogram (TEG) in the occurrence of venous thromboembolism (VTE) in patients with lung cancer after surgery.MethodsForty-one lung cancer patients with postoperative VTE in our hospital from September 2018 to August 2020 were enrolled into a thrombosis group, including 25 males and 16 females, aged 72.17±10.08 years. The 87 lung cancer patients who underwent surgery during the same period but did not suffer postoperative VTE were enrolled into a control group, including 51 males and 36 females, aged 71.06±9.49 years. The MA of thrombus in the TEG before and after the operation was compared between the two groups, and logistic regression analysis was used to test the value of the MA of thrombus at each time point in the TEG to predict the occurrence of VTE in patients with lung cancer surgery. The receiver operating characteristic curve was drawn to test the effectiveness of the MA of thrombus at each time point in the TEG to predict the occurrence of VTE in patients with lung cancer.ResultsThe MA of thrombus in the two groups after operation was greater than that before operation, and the MA of thrombus in the TEG on the day 3 after operation in the two groups> day 1> day 5 (P<0.05). The logistic regression analysis showed that the MA of thrombus in the TEG increased, which had predictive value for the occurrence of VTE in patients with lung cancer after surgery; the MA of thrombus in the TEG at each postoperative point was used as the test variable. Taking the occurrence of VTE as a state variable, the area under the curve (AUC) of MA of thrombus in the TEG on the 1st postoperative day was 0.82, and its optimal threshold was 75.15 mm; on the 3rd postoperative day, AUC was 0.88, and its optimal threshold was 80.05 mm; on the 5th day afterwards, AUC was 0.78, and its optimal threshold was 66.30 mm.ConclusionThe MA of TEG has a high predictive power for the occurrence of VTE in lung cancer patients after surgery, which suggests that TEG dynamic monitoring should be performed before surgery for lung cancer patients, and a reasonable anticoagulation plan should be formulated accordingly to reduce the occurrence of VTE.
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.
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.
ObjectiveTo systematically review the thromboembolic risk of Janus Kinase (JAK) inhibitors. MethodsWe searched PubMed, Embase, Cochrane Library, and Web of Science databases from inception to March 2025. Quality was assessed using Cochrane Risk of Bias-2. Stata 15 software was used for network meta-analysis. ResultsA total of 68 randomized controlled trials with a sample size of 39 059 were included. Findings did not show a significant difference between JAK inhibitors and placebo, methotrexate, tumor necrosis factor -α inhibitor, apremilast, otilimab in the risk of thromboembolism. ConclusionJAK inhibitors do not increase thromboembolism risk. To clarify the long-term safety of JAK inhibitors, future large-scale real-world studies with long-term follow-up are needed, especially in patients at risk of thromboembolism.