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Sakamoto T, Murakami Y, Hanaki T, Kihara K, Matsunaga T, Yamamoto M, Takano S, Tokuyasu N, Hasegawa T, Fujiwara Y. Evaluation of perioperative D-dimer concentration for predicting postoperative deep vein thrombosis following hepatobiliary-pancreatic surgery. Surg Today 2023:10.1007/s00595-023-02645-5. [PMID: 36710289 DOI: 10.1007/s00595-023-02645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/16/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE This study was performed to investigate the predictive value of the perioperative D-dimer concentration for the development of postoperative deep vein thrombosis (DVT) after hepatobiliary-pancreatic (HBP) surgery. METHODS The subjects of this retrospective study were 178 patients who underwent HBP surgery in our hospital between January, 2017 and December, 2021. The D-dimer concentration was measured preoperatively and on postoperative days (POD) 1, 3, and 5. Postoperative DVT was diagnosed based on compression ultrasonography in both lower limbs on POD 6 or 7. RESULTS Postoperative DVT developed in 21 (11.8%) of the 178 patients. The D-dimer concentration was significantly higher in the patients with than in those without postoperative DVT before surgery and on PODs 1, 3, and 5. The highest area under the curve of the D-dimer concentration for predicting DVT was 0.762 on POD 3. Multivariate analysis revealed that the D-dimer concentration on POD 3 was an independent predictive risk factor for postoperative DVT, along with the preoperative estimated glomerular filtration rate. Preoperative albumin and D-dimer concentrations were also identified as independent predictive factors of an increase in D-dimer concentration on POD 3. CONCLUSIONS The D-dimer concentration on POD 3 is a useful predictor of DVT after HBP surgery.
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Affiliation(s)
- Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan.
| | - Yuki Murakami
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Shuichi Takano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Toshimichi Hasegawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan
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Nan Y, Tiemuerniyazi X, Chen L, Song Y, Feng W, Xu F. Prognostic value of carbohydrate antigen 125 in patients undergoing surgical left ventricular reconstruction. Int J Cardiol 2023; 371:377-383. [PMID: 36208679 DOI: 10.1016/j.ijcard.2022.09.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/26/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Carbohydrate antigen 125 (CA125) is a biomarker often used in diagnosis of ovarian tumors. Studies also show that elevated CA125 implicates worse outcomes among patients with heart failure, while latter of which plays an important role in the pathophysiology of left ventricular aneurysm (LVA). However, the prognostic value of CA125 in LVA patients undergoing surgical left ventricular reconstruction (SLVR) remains unclear. METHODS In this single-centered cohort study, a total of 309 patients with LVA undergoing SLVR were retrospectively recruited. Univariable regression analysis was performed to identify the potential confounders for each outcome, followed by multivariable adjustment to confirm the association between CA125 and outcomes. The primary outcome was the overall mortality, and the secondary outcome was the major adverse cardiovascular and cerebrovascular events (MACCE) and perioperative outcomes. A receiver operating characteristic (ROC) curve was use to find the optimal cut-off value of CA125. RESULTS The median follow-up time was 55 months. The cohort was predominantly male (86.4%), with an average age of 58.6 years. Log (CA125) was associated with overall mortality (hazard ratio [HR]: 2.15, 95% confidence interval [CI]: 1.06-4.36, P = 0.033), prolonged hospital-stay time (HR:1.07, 95%CI: 1.03-1.12, P = 0.001) and increased risk of postoperative ventricular support (HR: 2.81, 95%CI: 1.10-7.18, P = 0.031) after multivariate adjustment. The optimal cut-off value for the CA125 for all-cause mortality was 13.825 U/ml with the area under curve of 0.675. CONCLUSION Elevated-CA125 implicates poorer short- and long-term prognosis in LVA patients undergoing SLVR.
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Affiliation(s)
- Yifeng Nan
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xieraili Tiemuerniyazi
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liangcai Chen
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangwu Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Fei Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Wu Y, Wang L, Yin Q, Deng L, Ma J, Tian X. Establishment and Validation of a Postoperative VTE Prediction Model in Patients with Colorectal Cancer Undergoing Radical Resection: CRSPOT Nomogram. Clin Appl Thromb Hemost 2023; 29:10760296231216966. [PMID: 37997283 PMCID: PMC10668569 DOI: 10.1177/10760296231216966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Venous thromboembolism (VTE) is a life-threatening postoperative complication of malignant tumors. We identified risk factors for postoperative VTE in patients undergoing radical resection of colorectal cancer (CRC) and constructed and validated a clinical prediction model. Clinical data of 982 patients undergoing radical resection of CRC from September 1, 2020, to March 31, 2022, in Ningxia Medical University General Hospital were analyzed retrospectively. Patients were randomly divided into training (n = 617) and validation groups (n = 264). Data included baseline characteristics, preoperative complications, examination results, and intraoperative and postoperative indicators. Logistic regression analysis was used to determine risk factors, build a predictive model, and draw a predictive nomogram (CRSPOT). Receiver operating characteristics (ROC) curve was used to calculate the area under the curve (AUC) for evaluating the model's predictive ability. Independent risk factors for postoperative VTE were as follows: postoperative hemoglobin of <10 g/L (odds ratio [OR] 0.413, 95% confidence interval [CI] 0.220-0.777), postoperative D-dimer of ≥3.5μg/mL (OR 2.156, 95% CI 1.145-4.061), BMI of ≥25 kg/m2 (OR 2.313, 95% CI 1.225-4.369), operation time of ≥4 h (OR 2.292, 95% CI 1.232-4.262), lower extremity varicose veins (OR 4.499, 95% CI 1.764-11.476), postoperative ileus (OR 5.760, 95% CI 2.031-16.337), and postoperative hypoxemia (OR 9.230, 95% CI 4.562-18.672). The nomogram's AUC was 0.826, demonstrating a reliable predictive ability. The CRSPOT nomogram reliably predicts postoperative VTE in patients undergoing radical resection of CRC, identifying high-risk patients early, allowing early implementation of antithrombotic strategies, and helping to reduce the incidence and mortality of postoperative VTE.
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Affiliation(s)
- Yanan Wu
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Lu Wang
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Qiaoli Yin
- Department of Anesthesiology, Peking University First Hospital Ningxia Women and Children's Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), PKUFH-NINGXIA Women & Children's Hospital (Maternal and Child Health Hospital of the Autonomous Region), Yinchuan, China
| | - Liqin Deng
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Junyang Ma
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaoxia Tian
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
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Li K, Yu M, Li H, Zhu Q, Wu Z, Wang Z, Tang Z. Establishment of Prediction Models for Venous Thromboembolism in Non-Oncological Urological Inpatients - A Single-Center Experience. Int J Gen Med 2022; 15:3315-3324. [PMID: 35360703 PMCID: PMC8961164 DOI: 10.2147/ijgm.s354288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/10/2022] [Indexed: 12/20/2022] Open
Abstract
Purpose Venous thromboembolism (VTE) comprises deep venous thrombosis (DVT) and pulmonary embolism (PE), which can lead to death. VTE is an insidious disease with no specific symptoms and overlooked readily. We aimed to establish prediction models for VTE in non-oncological urological inpatients to aid urologists to better identify VTE patients. Patients and Methods A retrospective analysis of 1453 inpatients was carried out. The risk factors for VTE had been clarified in our previous study. A stepwise regression method was used to screen the relevant influencing factors for VTE and construct a logistic regression prediction model to predict VTE. To validate the accuracy of the model, data from 291 patients from another cohort were used for external validation. Results A total of 1453 inpatients were enrolled. Five potential risk factors (previous VTE; treatment with anticoagulants or anti-platelet agents before hospital admission; D-dimer ≥0.89 μg/mL; lower-extremity swelling; chest symptoms) were selected by multivariable analysis with p < 0.05. These five risk factors were used to build a logistic regression prediction model. When p < 0.1 in the multivariable logistic regression model, two additional risk factors were added: Caprini score ≥5 and complications, and all seven risk factors were used to build another prediction model. Internal verification showed the cutoff values, sensitivity, and specificity of the two models to be 0.02474, 0.941, 0.816 (model 1) and 0.03824, 0.941, and 0.820 (model 2), respectively. Both models had good predictive ability, but prediction accuracy was 43.0% for both when using the data of the additional 291 inpatients in the two models. Conclusion Two novel prediction models were built to predict VTE in non-oncological urological inpatients. This is a new method for VTE screening, and internal validation showed a good performance. External validation results were suboptimal but may provide clues for subsequent VTE screening.
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Affiliation(s)
- Kaixuan Li
- Department of Urology, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China
| | - Meihong Yu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People's Republic of China.,Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Haozhen Li
- Department of Urology, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China
| | - Quan Zhu
- Department of Urology, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China
| | - Ziqiang Wu
- Department of Urology, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China
| | - Zhao Wang
- Department of Urology, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Changsha, 410008, People's Republic of China
| | - Zhengyan Tang
- Department of Urology, Xiangya Hospital of Central South University, Changsha, 410008, People's Republic of China.,Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, 410000, People's Republic of China
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Zheng Z, Wu Z, Li K, Zhu Q, Li H, Liu X, Wang G, Tang Z, Wang Z. Incidence and Risk Factors of Venous Thromboembolism in Patients After Transurethral Resection of the Prostate (TURP). Front Surg 2022; 8:744244. [PMID: 35198593 PMCID: PMC8858983 DOI: 10.3389/fsurg.2021.744244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Venous thromboembolism (VTE) in patients following transurethral resection of the prostate (TURP) has been overlooked for many years. This research was aimed to investigate the incidence and risk factors of VTE in patients after TURP. Methods A total of 451 patients who underwent TURP between January 2017 and December 2020 were retrospectively analyzed. Clinical data of the patients were collected, such as basic demographic data, prostate volume, creatinine values, hemoglobin values, surgery duration, Caprini score, international prostate symptom score (IPSS), quality of life (QOL) score, plasma D-dimer levels, and so on. Univariate analysis and multivariate logistic regression were performed to identify the potential risk factors of VTE. Venous ultrasonography of lower extremities was performed routinely to detect VTE for patients after TURP. Results In total, 36 (8%) out of the 451 patients suffered from VTE. A total of 12 (2.7%) patients were confirmed with deep venous thrombosis (DVT). Two patients (0.4%) were identified with pulmonary embolism (PE). Twenty-two (4.9%) patients were suffered from superficial venous thrombosis. Furthermore, according to the results of multivariate stepwise logistic regression analysis, having a history of VTE (adjusted odds ratio [aOR] = 10.980, 95% CI = 2.265–53.223), complicated with postoperative bladder hematoma (aOR = 6.302, 95% CI = 2.265–17.532), D-dimer >1.25 mg/L (aOR = 4.402, 95% CI = 1.798–10.774), and age >65 (aOR = 3.106, 95% CI = 1.084–8.893) were independent risk factors of VTE after TURP. In addition, the nomogram prediction model is a useful auxiliary prevention tool of VTE. Conclusion The incidence of VTE is severely underestimated in patients following TURP. A lot of asymptomatic VTEs have been overlooked. Early detection and diagnosis of VTE are essential. Nevertheless, further verifications based on the results of large-scaled studies are still needed.
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Affiliation(s)
- Zhihuan Zheng
- Xiangya Hospital, Central South University, Changsha, China
| | - Ziqiang Wu
- Xiangya Hospital, Central South University, Changsha, China
| | - Kaixuan Li
- Xiangya Hospital, Central South University, Changsha, China
| | - Quan Zhu
- Xiangya Hospital, Central South University, Changsha, China
| | - Haozhen Li
- Xiangya Hospital, Central South University, Changsha, China
| | - Xuesong Liu
- Xiangya Hospital, Central South University, Changsha, China
| | - Guilin Wang
- Xiangya Hospital, Central South University, Changsha, China
| | - Zhengyan Tang
- Xiangya Hospital, Central South University, Changsha, China.,Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, China
| | - Zhao Wang
- Xiangya Hospital, Central South University, Changsha, China
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Yamashita R, Nakamura M, Okayama Y, Kawase M, Muraoka N, Fujita A, Notsu A, Asakura K, Hashizume A, Shinsaka H, Matsuzaki M, Niwakawa M, Oya M. Incidence and location of perioperative deep vein thrombosis in patients with bladder cancer undergoing radical cystectomy. Int J Urol 2021; 29:259-264. [PMID: 34888958 DOI: 10.1111/iju.14760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the incidence and location of lower extremity deep vein thrombosis in patients undergoing radical cystectomy. METHODS We performed radical cystectomy in 137 patients with bladder cancer between August 2014 and February 2020. Since 2014, we have had a policy to screen for deep vein thrombosis using lower extremity ultrasonography both before and after radical cystectomy. We determined the incidence and location of deep vein thrombosis and classified it as either proximal or distal type. Furthermore, we explored the incidence of pulmonary embolism within 3 months after radical cystectomy. RESULTS After excluding six patients with a lack of ultrasonographic data, we evaluated 131 patients. Preoperative deep vein thrombosis (one proximal and 17 distal) was diagnosed in 18 patients (14%) with no symptoms. Postoperative deep vein thrombosis was diagnosed in 41 patients (31%; three proximal and 38 distal), of whom 26 (63%) had new-onset deep vein thrombosis after cystectomy. Three patients, two with proximal and one with distal type deep vein thrombosis, developed nonfatal pulmonary embolism postoperatively. Multivariate analysis showed that preoperative D-dimer levels (odds ratio 5.35, 95% confidence interval 1.74-16.50; P < 0.003), type of urinary diversion (ileal neobladder; odds ratio 11.15, 95% confidence interval 2.16-57.55; P = 0.004), and preoperative deep vein thrombosis (odds ratio 15.93, 95% confidence interval 3.82-66.30; P < 0.001) were significant risk factors for postoperative deep vein thrombosis. CONCLUSIONS Pre- and post-radical cystectomy whole-leg ultrasonography can lead to an early perioperative diagnosis and immediate treatment of proximal deep vein thrombosis, thereby potentially preventing fatal pulmonary embolism.
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Affiliation(s)
- Ryo Yamashita
- Division of Urology, Shizuoka Cancer Center, Shizuoka, Japan.,Department of Urology, Graduate School of Medicine, Keio University, Tokyo, Japan
| | | | - Yukiko Okayama
- Division of Physiological Examination, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Mizuki Kawase
- Division of Physiological Examination, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Nao Muraoka
- Division of Cardiology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Ayano Fujita
- Division of Cardiology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Koiku Asakura
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Hideo Shinsaka
- Division of Urology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Mototsugu Oya
- Department of Urology, Graduate School of Medicine, Keio University, Tokyo, Japan
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Wang Z, Li K, Zhu Q, Li H, Wu Z, Liu X, Tang Z. Incidence and risk factors of in-hospital venous thromboembolism in non-oncological urological inpatients: A single center experience. Asian J Urol 2021. [DOI: 10.1016/j.ajur.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Perioperative coagulofibrinolytic responses in colorectal surgery patients without chemical thromboprophylaxis: a retrospective observational study. Surg Today 2021; 52:904-913. [PMID: 34697683 PMCID: PMC9132822 DOI: 10.1007/s00595-021-02393-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/15/2021] [Indexed: 12/03/2022]
Abstract
Purpose During the perioperative period, coagulofibrinolytic activation occurs, which occasionally results in thromboembolic complications. However, natural perioperative coagulofibrinolytic responses have not been well investigated. The present study examined perioperative coagulofibrinolytic changes and their association with the development of venous thromboembolism (VTE). Methods We retrospectively analyzed the changes in coagulofibrinolytic markers for 7 days in 70 patients undergoing elective colorectal surgery. To explore the natural coagulofibrinolytic response, we investigated patients not undergoing perioperative chemical thromboprophylaxis. Results Coagulation activation occurred from just after surgery to postoperative day (POD) 1, followed by a gradual decrease, but persisted to even POD 7. Fibrinolytic activity showed a tri-phasic response: activation, shutdown and reactivation. Consequently, fibrin/fibrinogen degradation product (FDP) and D-dimer levels continued to increase until POD 7. The development of deep vein thrombosis (DVT) was observed in 11 patients (15.7%). Postoperative sustained hyper-coagulation [soluble fibrin (SF) or thrombin–antithrombin complex (TAT) values on POD 7 > their normal limits] was significantly associated with the development of DVT (SF, p < 0.001; TAT, p = 0.001). Conclusion We found initial coagulation activation and a tri-phasic response of fibrinolytic activity after colorectal surgery. Thus, physicians need to pay attention to these responses when attempting to prevent or treat VTE.
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Yuan HL, Zhang X, Li Y, Guan Q, Chu WW, Yu HP, Liu L, Zheng YQ, Lu JJ. A Nomogram for Predicting Risk of Thromboembolism in Gastric Cancer Patients Receiving Chemotherapy. Front Oncol 2021; 11:598116. [PMID: 34123774 PMCID: PMC8187914 DOI: 10.3389/fonc.2021.598116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose: The aims of this study were to develop and validate a novel nomogram to predict thromboembolism (TE) in gastric cancer (GC) patients receiving chemotherapy and to test its predictive ability. Methods: This retrospective study included 544 GC patients who received chemotherapy as the initial treatment at two medical centers. Among the 544 GC patients who received chemotherapy, 275 and 137 patients in the First Affiliated Hospital of Nanchang University from January 2014 to March 2019 were enrolled in the training cohort and the validation cohort, respectively. A total of 132 patients in the Beilun branch of the First Affiliated Hospital of Zhejiang University from January 2015 to August 2019 were enrolled in external validation cohorts. The nomogram was based on parameters determined by univariate and multivariate logistic analyses. The prediction performance of the nomogram was measured by the area under the receiver operating characteristic curve (AUROC), the calibration curve, and decision curve analysis (DCA). The applicability of the nomogram was internally and independently validated. Results: The predictors included the Eastern Cooperative Oncology Group Performance Status (ECOG), presence of an active cancer (AC), central venous catheter (CVC), and D-dimer levels. These risk factors are shown on the nomogram and verified. The nomogram demonstrated good discrimination and fine calibration with an AUROC of 0.875 (0.832 in internal validation and 0.807 in independent validation). The DCA revealed that the nomogram had a high clinical application value. Conclusions: We propose the nomogram for predicting TE in patients with GC receiving chemotherapy, which can help in making timely personalized clinical decisions for different risk populations.
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Affiliation(s)
- Hai-Liang Yuan
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China.,Department of Gastroenterology Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang Zhang
- Department of Gastroenterology Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Li
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Qing Guan
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Wei-Wei Chu
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Hai-Ping Yu
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Lian Liu
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Yun-Quan Zheng
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
| | - Jing-Jing Lu
- Department of Gastroenterology, Beilun Branch of the First Affiliated Hospital of Zhejiang University, Ningbo, China
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Tang G, Qi L, Sun Z, Liu J, Lv Z, Chen L, Huang B, Zhu S, Liu Y, Li Y. Evaluation and analysis of incidence and risk factors of lower extremity venous thrombosis after urologic surgeries: A prospective two-center cohort study using LASSO-logistic regression. Int J Surg 2021; 89:105948. [PMID: 33892158 DOI: 10.1016/j.ijsu.2021.105948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/19/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Deep vein thrombosis (DVT) is among the most frequent complications of surgery. This study aimed to analyse the incidence and risk factors of lower extremity venous thrombosis after urologic surgery. MATERIALS AND METHODS This prospective two-centre study was conducted from August 2019 to January 2020. Patients who underwent urological procedures were enrolled. The primary endpoint was the detection of asymptomatic or symptomatic DVT of the lower extremity within 7 days after surgery. Univariate and least absolute shrinkage and selection operator (LASSO) logistic regression analyses were performed. RESULTS Fifty-six of 1011 patients developed DVT. In the univariate analysis, Barthel Index ≤40, d-dimer level ≥0.5 mg/L and age ≥60 years (p < 0.001) were identified as the most significant risk factors. The LASSO logistic regression model identified nine factors: age, history of DVT, lymph node dissection, perioperative steroid use, Caprini score, Barthel Index, D-dimer level, cystectomy, and prostatectomy. CONCLUSION Our study used the LASSO logistic regression model to provide reliable data on the risk factors for DVT after comprehensive urologic surgery. The incidence of DVT in this group was 5.54%. This might facilitate individualised anticoagulant management in patients undergoing urological procedures.
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Affiliation(s)
- Guyu Tang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Zepeng Sun
- Department of Statistics, School of Mathematics and Statistics, Beijing Technology and Business University, Haidian, Beijing, 100048, China
| | - Jing Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Zhengtong Lv
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Lingxiao Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Bin Huang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Shuai Zhu
- Department of Urology, Hunan Cancer Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Yao Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Yuan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
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Chang W, Wang B, Li Q, Zhang Y, Xie W. Study on the Risk Factors of Preoperative Deep Vein Thrombosis (DVT) in Patients With Lower Extremity Fracture. Clin Appl Thromb Hemost 2021; 27:10760296211002900. [PMID: 33754840 PMCID: PMC7995307 DOI: 10.1177/10760296211002900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: The objective of this work is to discuss and analyze the related factors of lower extremity fracture complicated by preoperative deep vein thrombosis (DVT). Methods: A total of 11,891 patients with closed fractures of lower extremities were selected. By analyzing each patient’s gender, age, presence or absence of diabetes and hypertension, preoperative plasma D-dimer level, and color Doppler ultrasound of the lower extremity vein, the pertinent factors of the patients with lower extremity fractures complicated by preoperative DVT were analyzed. Results: A total of 578 with preoperative DVT were detected, displaying a total incidence of 4.86%. All patients were categorized into either the DVT group or non-DVT group. The results demonstrate that there were statistically significant differences between the 2 groups in age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level (P < 0.05). Logistic multivariate analysis revealed that age, the presence of diabetes, and the preoperative plasma D-dimer level of patients were independent risk factors for lower extremity fracture complicated by DVT. Conclusion: Age, the presence of diabetes, the fracture site, and increased D-dimer levels were found to be potential risk factors and indicators for preoperative DVT in patients with lower extremity fractures. In addition, the preoperative plasma D-dimer level has certain guiding significance for the prediction of venous thrombosis after lower extremity fracture, which is conducive to the early prediction and diagnosis of DVT, but it often must be followed with good clinic acumen and examinations.
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Affiliation(s)
- Wenjie Chang
- 74738Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Bin Wang
- Laizhou Hospital of Traditional Chinese Medicine, Laizhou, China
| | - Qiwei Li
- 74738Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongkui Zhang
- Department of Orthopedic Surgery, 159393Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Lixia District, Jinan City, Shandong Province, China
| | - Wenpeng Xie
- Department of Orthopedic Surgery, 159393Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Lixia District, Jinan City, Shandong Province, China
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Alabyad D, Rangaraju S, Liu M, Imran R, Kempton CL, Sharifpour M, Auld SC, Gaddh M, Sniecinski R, Maier CL, Guarner J, Duncan A, Nahab F. Validation of an admission coagulation panel for risk stratification of COVID-19 patients. PLoS One 2021; 16:e0248230. [PMID: 33740793 PMCID: PMC7979266 DOI: 10.1371/journal.pone.0248230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/22/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is limited data on the markers of coagulation and hemostatic activation (MOCHA) profile in Coronavirus disease 2019 (COVID-19) and its ability to identify COVID-19 patients at risk for thrombotic events and other complications. METHODS Hospitalized patients with confirmed SARS-COV-2 from four Atlanta hospitals were included in this observational cohort study and underwent admission testing of MOCHA parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer). Clinical outcomes included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, access line thrombosis, ICU admission, intubation and mortality. MAIN RESULTS Of 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American), 45 (16%) had a thrombotic endpoint. Each MOCHA parameter was independently associated with a thrombotic event (p<0.05) and ≥ 2 abnormalities was associated with thrombotic endpoints (OR 3.3, 95% CI 1.2-8.8) as were admission D-dimer ≥ 2000 ng/mL (OR 3.1, 95% CI 1.5-6.6) and ≥ 3000 ng/mL (OR 3.6, 95% CI 1.6-7.9). However, only ≥ 2 MOCHA abnormalities were associated with ICU admission (OR 3.0, 95% CI 1.7-5.2) and intubation (OR 3.2, 95% CI 1.6-6.4). MOCHA and D-dimer cutoffs were not associated with mortality. MOCHA with <2 abnormalities (26% of the cohort) had 89% sensitivity and 93% negative predictive value for a thrombotic endpoint. CONCLUSIONS An admission MOCHA profile is useful to risk-stratify COVID-19 patients for thrombotic complications and more effective than isolated d-dimer for predicting risk of ICU admission and intubation.
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Affiliation(s)
- Darwish Alabyad
- Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Srikant Rangaraju
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Michael Liu
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Rajeel Imran
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Christine L. Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Milad Sharifpour
- Division of Critical Care Medicine, Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Sara C. Auld
- Emory Critical Care Center, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Manila Gaddh
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Roman Sniecinski
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Cheryl L. Maier
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Alexander Duncan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Fadi Nahab
- Department of Neurology & Pediatrics, Emory University, Atlanta, Georgia, United States of America
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Zeng H, Gao M, Chen J, Cui Y, Huang F, Zeng F, Yang Z, Li Y, Chen Z, Zhu Z, Chen H. Incidence and risk factors of venous thromboembolism after percutaneous nephrolithotomy: a single-center experience. World J Urol 2021; 39:3571-3577. [PMID: 33725149 DOI: 10.1007/s00345-021-03658-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/06/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the incidence and risk factors of the venous thromboembolism (VTE) in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS We retrospectively reviewed the records of 896 consecutive cases receiving PCNL between July 2018 and August 2020 in our institution. Univariate analysis was performed to identify the risk factors of VTE, and multivariate logistic regression analysis was further performed to determine the independent risk factors. Furthermore, the corresponding nomogram was conducted to establish a predicted model for VTE. RESULTS The overall incidence of VTE was 2.8%. The multivariate logistic regression analysis showed that discontinued anticoagulant or antiplatelet therapies (OR 4.505, 95% CI 1.410-14.401), increased postoperative 12-h D-dimer (OR 11.162, 95% CI 2.370-52.574), hydronephrosis (OR 3.303, 95% CI 1.303-8.375), higher Caprini risk assessment model (RAM) score (OR 3.233, 95% CI 1.207-8.659) and postoperative sepsis or septic shock (OR 3.784, 95% CI 1.163-12.306) were independent risk factors of VTE following PCNL. Moreover, the area under the curve of postoperative 12-h D-dimer, hydronephrosis and Caprini RAM score was 0.826, 0.621 and 0.660, respectively. Based on the identified independent risk factors, the well-calibrated nomogram showed a moderate discriminative ability with concordance index 0.731. CONCLUSIONS 2.8% of patients developed VTE following PCNL. Regarding those patients who have independent risk factors in this study, due attention should be paid to the effective thromboprophylaxis and the early detection of VTE.
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Affiliation(s)
- Huimin Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Meng Gao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yu Cui
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Fang Huang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Zhongqing Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China.
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China.
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14
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Wu ZQ, Li KX, Zhu Q, Li HZ, Tang ZY, Wang Z. Application value of D-dimer testing and Caprini risk assessment model (RAM) to predict venous thromboembolism (VTE) in Chinese non-oncological urological inpatients: a retrospective study from a tertiary hospital. Transl Androl Urol 2020; 9:1904-1911. [PMID: 33209654 PMCID: PMC7658137 DOI: 10.21037/tau-20-320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background The Caprini risk assessment model (RAM) and D-dimer testing have been widely used in the prediction of venous thromboembolism (VTE). However, the clinical significance of these testing options are limited in non-oncological urological inpatients because of the low specificity. Methods This retrospective study included 1,453 patients who were admitted to the non-oncological unit of the Department of Urology, Xiangya Hospital, Central South University, from January 2018 to December 2018. The highest score of Caprini RAM and the highest D-dimer level were collected in this retrospective study. Ultrasound examinations of the lower extremities or computed tomographic pulmonary arteriography (CTPA) were applied to patients who were suspected of having VTE, if necessary. Results A total of 1,453 patients were collected in this study, which included 34 VTE and 1,419 non-VTE patients. The threshold of D-dimer was 0.89 µg/mL, according to the receiver operating characteristic (ROC) curve, with a sensitivity of 82.4%, a specificity of 83.3%, and a negative predictive value (NPV) of 99.5%. The cut-off of the Caprini RAM was 5, with a sensitivity of 76.5%, a specificity of 58.7%, and an NPV of 99.0%. The area under the curve (AUC) was higher for D-dimer (0.86) than for the Caprini score (0.73). Conclusions The application of 0.89 µg/mL and a score of 5 as cut-offs for D-dimer testing and Caprini RAM, respectively, could safely decrease the proportion of Chinese non-oncological urological inpatients who needed to undergo further examinations. These new findings may enhance the application value of D-dimer testing and Caprini RAM for Chinese non-oncological urological inpatients.
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Affiliation(s)
- Zi-Qiang Wu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Kai-Xuan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Quan Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Hao-Zhen Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zheng-Yan Tang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, China
| | - Zhao Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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15
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Wang P, Zhao H, Zhao Q, Ren F, Shi R, Liu X, Liu J, Liu H, Chen G, Chen J. Risk Factors and Clinical Significance of D-Dimer in the Development of Postoperative Venous Thrombosis in Patients with Lung Tumor. Cancer Manag Res 2020; 12:5169-5179. [PMID: 32636679 PMCID: PMC7335272 DOI: 10.2147/cmar.s256484] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The incidence of venous thromboembolism (VTE) is higher in patients with lung cancer. The aim of this study was to investigate the risk factors associated with postoperative VTE and explore the VTE predication capacity of D-dimer kinetics. PATIENTS AND METHODS Six hundred patients who had lung tumor surgery were analyzed retrospectively between January 2018 and August 2019, and venous ultrasound imaging and D-dimer examination before and after surgery were recommended to all operative patients. Of these 600 patients, 523 patients had venous thromboembolism after surgery, and 77 patients had not found. The general clinical data, postoperative prophylactic anticoagulant therapy, early systemic thromboprophylaxis, 50% increment of D-dimer, 100% increment of D-dimer, and perioperative (preoperative and days 1, 3, and 5 after surgery) D-dimer levels were collected. Logistic regression analysis was used to analyze the independent risk factors of postoperative VTE. RESULTS VTE developed in 77 (12.8%) patients. In a univariate analysis, age, surgical approach, tumor size, histology, postoperative preventive anticoagulation, postoperative limb compression therapy, postoperative hemostasis, duration of operation, early systemic thromboprophylaxis, 100% increment of D-dimer, preoperative and postoperative D-dimer level, intraoperative blood loss, and time spent in the hospital were significantly different between the thrombus group and nonthrombus group (P < 0.05). Multivariate analysis showed that age >60 years (P = 0.006) and D-dimer level on 5 days after surgery (P = 0.000) were significant independent risk factors for VTE. Postoperative D-dimer was significantly higher than the preoperative level (P < 0.001). Postoperative D-dimer level was significantly different between benign and malignant tumor groups (P < 0.05) and between the thrombus group and nonthrombus group (P < 0.001). Preventive anticoagulation and limb compression therapy starting from the first day after surgery was statistically significant between the thrombus group and the nonthrombus group (P < 0.05). CONCLUSION Continuous detection of D-dimer level after pulmonary tumor surgery combined with thrombotic-related risk factors can better evaluate the occurrence of VTE. Preventive anticoagulant therapy and limb compression therapy starting from the first day after surgery can effectively reduce the incidence of VTE.
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Affiliation(s)
- Pan Wang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Honglin Zhao
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Qingchun Zhao
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Fan Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Ruifeng Shi
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Xingyu Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Jinghao Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Gang Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
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16
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Yu R, Nansubuga F, Yang J, Ding W, Li K, Weng D, Wu P, Chen G, Ma D, Wei J. Efficiency and safety evaluation of prophylaxes for venous thrombosis after gynecological surgery. Medicine (Baltimore) 2020; 99:e20928. [PMID: 32569239 PMCID: PMC7310966 DOI: 10.1097/md.0000000000020928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/04/2020] [Accepted: 05/25/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In this study, we investigate the incidence of venous thrombosis (VT), and evaluate the effectiveness and safety of 3 major thromboprophylaxes and the potential risk factors for VT in women undergoing surgery for a gynecological malignancy. METHODS We performed a randomized controlled trial of 307 patients undergoing laparoscopic surgery for gynecological malignancies at a single institution from January 2016 to October 2017. Patients were divided into 3 groups: one receiving a half dose of low-molecular-weight heparin sodium injection (FLUXUM, Alfa Wassermann, Italy) delivered by injection, one receiving a full dose of FLUXUM, and a third group receiving an Argatroban injection. RESULTS None of the patients in our study developed a pulmonary embolism, bleeding, or infectious complications. There were no statistical differences in the rate of deep venous thrombosis (DVT) (0%, 0%, and 2.38%) and the superficial venous thromboembolism (SVT) (15.66%, 8.97%, and 18.6%) among the 3 groups. None of the patients developed symptomatic VT. The effect of treatment on alanine aminotransferase and aspartate aminotransferase differed between the groups, with a minimal effect in the Argatroban group, and all 3 methods resulted in minimal impairment of renal function. Decreased hemoglobin, elevated levels of D-dimer, and prothrombin time were closely related to thrombogenesis. CONCLUSION In conclusion, the incidence of postoperative thrombosis in gynecological malignancy among these Chinese people is not as low as we had originally presumed. Argatroban is not more effective than Parnaparin as a direct thrombin inhibitor, but it has less influence on liver function, which is beneficial for patients undergoing chemotherapy. Hemoglobin, D-dimer, and prothrombin time may be used to predict or detect thrombogenesis.
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Affiliation(s)
- Ruidi Yu
- Department of Obstetrics and Gynecology
| | | | - Jun Yang
- Division of Vascular Surgery, Hepatic Surgery Center, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | | | - Kezhen Li
- Department of Obstetrics and Gynecology
| | | | - Peng Wu
- Department of Obstetrics and Gynecology
| | - Gang Chen
- Department of Obstetrics and Gynecology
| | - Ding Ma
- Department of Obstetrics and Gynecology
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17
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Harsfalvi J, Molnar Z, Csanyi MC, Domjan I, Flasko T, Kaposi A, Benyo M. Long-lasting prothrombotic state implied by changes of plasma von Willebrand factor parameters after radical prostatectomy for prostate malignancy. Urol Oncol 2019; 38:191-197. [PMID: 31711834 DOI: 10.1016/j.urolonc.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/27/2019] [Accepted: 10/07/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Thromboembolic complications are present in 0.8%-16.8% of the cases after radical prostatectomy (RP). Association between elevated plasma von Willebrand factor (VWF) levels-as an endothelial activation marker-and increased risk of thrombotic events has been evidenced. We aimed to elicit new data on the VWF after RP in prostate cancer patients and explore the role of it as a thrombotic risk factor. Upon perioperative plasma VWF levels (VWF:Ag) its collagen-binding (CB) activity (VWF:CB), multimerization, and cleaving enzyme (ADAMTS13 [a disintegrin and metalloprotease with thrombospondin type repeats, motif 1, type 13]) of the VWF multimers were quantitated along with Factor VIII and routine laboratory parameters in this observational pilot study. METHODS Plasma samples of 24 prostate cancer patients were collected before (-1 day; D-1) and after RP (1 hour, 6 days, 1 month, and 10 months; H1, D6, M1, and M10). VWF:Ag, VWF:CB, ADAMTS13:Ag were measured by ELISA, and the multimer distribution by electrophoresis and quantitative densitometry. Factor VIII, fibrinogen, D-dimer, and other routine laboratory parameters were determined as well. Preoperative values served as baselines which were compared to controls (24 healthy individuals). RESULTS VWF:Ag and CB elevated by 122% and 143% respectively at H1 after RP then plateaued at D6 compared to baseline values. ADAMTS13/VWF:Ag ratio reduced by 41% at H1, and by 46% at D6, meanwhile the ratio of high molecular weight multimers increased as well. Values returned to baseline at M1 and further reduced to the levels of the controls at M10. All of the 24 patients at H1 and D6 and 14 at M10 were in potential prothombotic state according ROC analysis of the VWF parameters as indicators. CONCLUSIONS Prostate malignancy and then surgical stress, and inflammatory reactions induced release of VWF from the endothelial cells, along with an increasing amount of large multimers and relative reduction of ADAMTS13 level. Because these changes mark a prothrombotic state even at M1 after RP, more than 1 month follow-up and prophylactic targeting through the thrombotic and inflammatory activity of the VWF is proposed. Evaluation of VWF parameters provides new information about the long-term disturbances of primary hemostasis after radical pelvic oncologic surgery like RP and might improve the understanding the physiological and pathological recovery.
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Affiliation(s)
- Jolan Harsfalvi
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.
| | - Zsuzsanna Molnar
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Department of Laboratory, Grof Tisza Istvan Hospital, Berettyoujfalu, Hungary
| | - Maria Cs Csanyi
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Istvan Domjan
- Department of Urology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Department of Urology, Josa Andras Hospital, Hospitals of Szabolcs-Szatmar-Bereg County, Nyiregyhaza, Hungary
| | - Tibor Flasko
- Department of Urology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andras Kaposi
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Matyas Benyo
- Department of Laboratory, Grof Tisza Istvan Hospital, Berettyoujfalu, Hungary; Department of Urology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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18
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Li J, Zhang F, Liang C, Ye Z, Chen S, Cheng J. The Diagnostic Efficacy of Age-Adjusted D-Dimer Cutoff Value and Pretest Probability Scores for Deep Venous Thrombosis. Clin Appl Thromb Hemost 2019; 25:1076029619826317. [PMID: 30754991 PMCID: PMC6715010 DOI: 10.1177/1076029619826317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/24/2018] [Accepted: 12/31/2018] [Indexed: 01/01/2023] Open
Abstract
This study seeks to evaluate the diagnostic value of D-Dimer Plus and Innovance D-Dimer as well as the age-adjusted cutoff value for D-dimer detection in combination with 4 pretest probability (PTP) scores for deep venous thrombosis (DVT). A total of 688 patients referred for lower extremity vascular compression venous ultrasonography for suspected DVT from January 2016 to May 2018 in the First Affiliated Hospital of Sun Yat-sen University underwent D-dimer tests combining with 4 PTP scores. The diagnostic efficacy of the Wells score was the highest of the 4 PTP scores. The diagnostic efficacy of Innovance D-Dimer for DVT was greater than that of D-Dimer Plus, with better sensitivity and negative predictive value, which were both greater than 98%. If the cutoff values were adjusted by age, the Innovation D-Dimer could further improve both the specificity and the positive predictive value, providing better diagnostic performance. When the 2 D-dimer detections were used in combination with 4 PTP scores for DVT diagnosis, separately, both the positive predictive value and the negative predictive value significantly improved for D-Dimer Plus, and the positive predictive values significantly improved for Innovance D-Dimer. However, the sensitivity, specificity, and negative predictive values did not obviously change. For our patients, Wells score had the best diagnostic efficacy for our patients with suspected DVT among the 4 PTP scores. Innovance D-Dimer in combination with age-adjusted cutoff values exhibited increased sensitivity and negative predictive value for DVT diagnosis and was equivalent to the diagnostic efficacy of the Innovance D-Dimer in combination with PTP scores.
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Affiliation(s)
- Junxun Li
- Department of Medical Laboratory, The First Affiliated Hospital of Sun
Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
- Junxun Li and Fan Zhang contributed equally to this study and should be
considered as co-first author
| | - Fan Zhang
- Department of Medical Laboratory, The First Affiliated Hospital of Sun
Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
- Junxun Li and Fan Zhang contributed equally to this study and should be
considered as co-first author
| | - Chujia Liang
- Department of Medical Laboratory, The First Affiliated Hospital of Sun
Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Zhuangjian Ye
- Department of Medical Laboratory, The First Affiliated Hospital of Sun
Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Shaoqian Chen
- Department of Medical Laboratory, The First Affiliated Hospital of Sun
Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jing Cheng
- Department of Medical Laboratory, The First Affiliated Hospital of Sun
Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
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19
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Dai H, Zhou H, Sun Y, Xu Z, Wang S, Feng T, Zhang P. D-dimer as a potential clinical marker for predicting metastasis and progression in cancer. Biomed Rep 2018; 9:453-457. [PMID: 30402229 DOI: 10.3892/br.2018.1151] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/13/2018] [Indexed: 12/27/2022] Open
Abstract
D-dimer is a widely used biomarker for indicating the activation of coagulation and fibrinolysis, and is reported to serve important roles in cancer progression. The aim of the current retrospective study was to investigate the association of D-dimer plasma level with the development of various cancers. Patients with breast (n=86), gastric (n=317), pancreatic (n=37), colon (n=153) and rectal (n=137) cancers and 92 healthy volunteers were assessed in the present study. Plasma levels of D-dimer in the patients and healthy controls were measured by immunoturbidimetric assays. The association of D-dimer levels with the clinicopathological features of patients were also determined. The plasma levels of D-dimer were significantly higher in patients with breast cancer (P=0.0022), gastric cancer (P<0.0001), pancreatic cancer (P=0.0003), colon cancer (P=0.0001) and rectal cancer (P=0.0028), compared with the healthy controls. It was also determined that the plasma D-dimer levels were positively associated with clinical cancer stage (P<0.05) and metastasis (P<0.05). These findings suggested that the plasma D-dimer level may be used as marker for predicting cancer metastasis and progression.
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Affiliation(s)
- Hong Dai
- Department of Clinical Laboratory, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China.,Department of General Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Hongxing Zhou
- Department of Clinical Laboratory, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Yingxin Sun
- Department of Clinical Laboratory, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Zhe Xu
- Department of Clinical Laboratory, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Shuo Wang
- Department of Clinical Laboratory, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Tongbao Feng
- Department of Clinical Laboratory, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Ping Zhang
- Department of Clinical Laboratory, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
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