Analysis of risk factors for deep venous thrombosis in patients with gynecological malignant tumor: A clinical study

Gynecological Cancer and Venous Thromboembolism: A Narrative Review to Increase Awareness and Improve Risk Assessment and Prevention

The prevention and appropriate management of venous thromboembolism in cancer patients is of paramount importance. However, the literature data report an underestimation of this major problem in patients with gynecological cancers, with an inconsistent venous thromboembolism risk assessment and prophylaxis in this patient setting. This narrative review provides a comprehensive overview of the available evidence regarding the management of venous thromboembolism in cancer patients, focusing on the specific context of gynecological tumors, exploring the literature discussing risk factors, risk assessment, and pharmacological prophylaxis. We found that the current understanding and management of venous thromboembolism in gynecological malignancy is largely based on studies on solid cancers in general. Hence, further, larger, and well-designed research in this area is needed.

Analysis of Risk Factors of Postoperative Lower Extremity Deep Venous Thrombosis in Patients With Cervical Cancer

Deep venous thrombosis (DVT) has a significant negative impact on surgical and tumor patient's safety and quality of life. There was no specific report on the incidence and risk factors of postoperative lower extremity DVT in cervical cancer patients. Analysis of the risk factors of postoperative DVT in patients with cervical cancer is of great clinical significance for prevention and treatment. We retrospectively analyzed 309 cervical cancer patients treated by the Hubei Cervical Cancer Prevention Center and used a logistic regression model to test the risk variables of postoperative lower extremity deep venous thrombosis in cervical cancer patients. By univariate analyses, the results of the study showed that the incidence of postoperative DVT was significantly increased in cervical cancer patients complicated with old age, obesity, high preoperative plasma D-dimer level, increased preoperative triglyceride level, chronic diseases (hypertension, diabetes, and cardiovascular disease), open surgery, long operation time, intraoperative blood transfusion, advanced tumor stage, and preoperative chemotherapy/radiotherapy. Advanced age, obesity, elevated preoperative D-dimer level, high preoperative triglyceride level, and open surgery were independent risk factors for postoperative lower extremity DVT in patients with cervical cancer by multivariate regression analyses (all P < .05). In gynecologic patients with cervical cancer, there is a high incidence of postoperative lower extremity DVT. Clinicians should develop systematic and comprehensive prevention and treatment measures for the risk factors to lower this morbidity and improve patient prognosis.

A nomogram model for predicting lower extremity deep vein thrombosis after gynecologic laparoscopic surgery: a retrospective cohort study

Objective

To investigate the risk factors associated with lower extremity deep vein thrombosis (LEDVT) and to establish a predictive model for patients who undergo gynecologic laparoscopic surgery.

Methods

A review of clinical data was conducted on patients who underwent gynecologic laparoscopic surgery between November 1, 2020, and January 31, 2022. Patients who developed LEDVT after surgery were included as the observation group, while the control group comprised patients who did not experience complications. Multivariate forward stepwise logistic regression models were used to identify independent risk factors associated with LEDVT. A nomogram model was then developed based on these risk factors.

Results

A total of 659 patients underwent gynecologic laparoscopic surgery during the study period, and 52 (7.89%) of these patients developed postoperative LEDVT. Multivariate logistic regression analysis showed that older age (adjusted OR, 1.085; 95% CI [1.034-1.138]; P < 0.05), longer operation duration (adjusted OR, 1.014; 95% CI [1.009-1.020]; P < 0.05), shorter activated partial thromboplastin time (APTT) (adjusted OR, 0.749; 95% CI [0.635-0.884]; P < 0.05), higher D-dimer (adjusted OR, 4.929; 95% CI [2.369-10.255]; P < 0.05), higher Human Epididymis Protein 4 (HE4) (adjusted OR, 1.007; 95% CI [1.001-1.012]; P < 0.05), and history of hypertension (adjusted OR, 3.732; 95% CI [1.405-9.915]; P < 0.05) were all independent risk factors for LEDVT in patients who underwent gynecologic laparoscopic surgery. A nomogram model was then created, which had an area under the curve of 0.927 (95% CI [0.893-0.961]; P < 0.05), a sensitivity of 96.1%, and a specificity of 79.5%.

Conclusions

A nomogram model that incorporates information on age, operation duration, APTT, D-dimer, history of hypertension, and HE4 could effectively predict the risk of LEDVT in patients undergoing gynecologic laparoscopic surgery, potentially helping to prevent the development of this complication.

Effects of Cognitive-Behavioral Therapy on Psychological Resilience, Social Adaptation and Clinical Efficacy of Patients with Bone Tumors

Objective

To evaluate the effects of cognitive-behavioral therapy on psychological resilience, social adaptation and clinical efficacy in patients with bone tumors.

Methods

This is a retrospective study. Eighty patients with bone tumor admitted to Baoding No.1 Central Hospital were included and randomly divided into two groups: the experimental group and the control group, with 40 cases in each group from March 2020 to February 2022. Patients in the control group were given conventional specialist care, while those in the experimental group were given cognitive-behavioral therapy on top of the treatment in the control group. The differences in quality of life before and after treatment between the two groups were compared and analyzed.

Results

The levels of SAS and SDS were significantly lower in the experimental group compared to the control group, with statistically significant differences (p<0.05). The satisfaction level in the experimental group was higher than in the control group, with statistically significant difference (p=0.04). In addition, the psychological resilience scores of adaptability, toughness, control and goal achievement in the experimental group were significantly improved compared with those in the control group, with statistically significant differences (p<0.05); The cognitive scores in the experimental group were significantly higher than those in the control group, with statistically significant difference (p<0.05).

Conclusion

Cognitive-behavioral therapy is an effective regimen for patients suffering from bone tumors, boasting various benefits such as significantly enhanced patient compliance with treatment, improved quality of life, increased resilience, ameliorated anxiety and depressive states, and improved treatment efficacy and patient satisfaction.

Prevalence and risk factor of post-operative lower extremities deep vein thrombosis in patients undergoing gynecologic surgery: a single-institute cross-sectional study

Background and aim

The study of prevalence and risk factors of postoperative lower limb deep vein thrombosis (DVT) in Thai gynecologic patients was limited. The present study was conducted to evaluate this issue.

Methods

The patients were age > 15 years old without a history of DVT or pulmonary emboli (PE) scheduled for laparotomy or vaginal gynecologic surgery between May and November 2020 were invited to participate. All of these patients were scheduled for a complete duplex ultrasound to detect lower limb DVT 72 h before and within 14 days after the operation. The patients without DVT were scheduled for an interview by telephone about DVT symptoms 30 days after the operation. The clinical variables were compared using univariate and multivariate analysis to identify the independent factors related to the development of DVT.

Results

One hundred and twelve patients met the inclusion criteria. Of these patients, 44 cases (39.3%) were diagnosed as malignancy and 102 patients underwent a hysterectomy. Post-operative DVTs were detected in six patients (5.4%) and all except one had a malignancy. Thus, the prevalence of DVT in malignancy cases was five in 44 patients (11.4%). The independent risk factors for postoperative DVT were age > 60-year-old and receiving a perioperative blood transfusion. Five of six DVT patients received low molecular-weight heparin for treatment of DVT and none developed PE. The rest of the participants reported no symptom-related DVTs from the interview 30 days after the operation.

Conclusion

The prevalence of postoperative DVT in gynecologic patients was 5%, and the independent risk factors were elderly patients and receiving a perioperative blood transfusion.

Correlation between serum factor VIII:C levels and deep vein thrombosis following gynecological surgery

Deep vein thrombosis (DVT) is common in patients following gynecological surgery. Coagulation factor VIII (FVIII) is an important part of the human coagulation system, and FVIII:C is a component of FVIII with anticoagulant activity. 800 patients who underwent gynecological surgery were enrolled. General clinical data were harvested, and pre – and postoperative serum FVIII levels were determined. Lower-extremity ultrasound examination and/or postoperative pulmonary angiography were performed. Related data were analyzed statistically. DVT was the first manifestation of venous thromboembolism in all cases. There were a total of 46 cases, and the incidence of DVT was 5.8%. Progression to pulmonary embolism was confirmed in 16 cases, with an incidence of 2.0%. The independent risk factors for DVT after gynecological surgery were postoperative FVIII:C levels (odds ratio [OR] = 1.01), age (OR = 6.57), and operation time ≥3 hours (OR = 2.90) (P < 0.05). When the FVIII:C level was greater than the 75th centile (≥150 IU/dL), the risk of DVT was 2.99 times higher than that below the 25th centile (<100 IU/dL) (P < 0.05). When combined with the risk factor of operation time ≥3 hours, the risk increased to 3.17 times (P = 0.10). When combined with age ≥60 years, the risk was significantly increased, reaching 12.0 times (P < 0.05). Serum FVIII:C levels are an independent risk factor for DVT after gynecological surgery. Higher levels increase the risk of DVT after gynecological surgery, and they may have a dose-dependent relationship. A synergistic effect exists in combination with other risk factors, which further increases the risk.

Risk Prediction and Treatment of LE-DVT in Patients with Chronic Radiation Intestinal Injury: A Retrospective Case-Control Study

Background

Chronic radiation intestinal injury (CRII) is the most common complication after pelvic malignancy radiation. Once hemorrhagic CRII patients suffer from lower extremity deep venous thrombosis (LE-DVT), hemostasis and anticoagulation therapy will be adopted simultaneously, but the treatment strategy is a paradox, as the condition is extremely intractable and serious. The aim of this study was to investigate the prevalence of and risk factors for LE-DVT in CRII patients and explore the treatment of hemorrhagic CRII patients with LE-DVT.

Methods

This was a retrospective study, and a total of 608 hospitalized CRII patients after pelvic radiotherapy were included from November 2011 to October 2018. Univariate and multivariate analyses were conducted to investigate the potential risk factors for LE-DVT in CRII patients. Furthermore, the treatment of hemorrhagic CRII patients with LE-DVT was explored.

Results

Among the CRII patients, 94 (15.5%) were with suspicious symptoms of LE-DVT in the lower limbs, and 32 (5.3%) were diagnosed with LE-DVT. Among the patients with LE-DVT, 65.6% (21/32) had bleeding simultaneously, and 29 (90.6%) had anemia with 24 (75.0%) having moderate to severe anemia. Multivariate analysis showed that a recent surgical history (≤6 months) (OR = 5.761, 95% CI: 2.506~13.246, p < 0.001), tumor recurrence or metastasis (OR = 3.049, 95% CI: 1.398~6.648, p = 0.005) and the hemoglobin (Hb) level (OR = 0.960, 95% CI: 0.942~0.979, p < 0.001) were significantly associated with the development of LE-DVT. ROC curve analysis showed that the AUC of the merged risk score of the independent risk factors was 0.822 (95% CI: 0.789~0.852), and the optimal Hb cutoff was 82.5 g/L. After colostomy, obvious bleeding remission was rapidly found in 84.6% of hemorrhagic CRII patients with LE-DVT.

Conclusion

The prevalence of LE-DVT in hospitalized CRII patients was 5.3%. A recent surgical history, tumor recurrence or metastasis and a lower Hb level were independently associated with LE-DVT development in CRII patients. Colostomy could be a good choice for intractable hemorrhagic CRII patients with LE-DVT.

[Clinical analysis of head and neck malignant tumor patients with postoperative venous thromboembolism]

Objective:To investigate the incidence, risk factors, prevention and treatment of venous thromboembolism（VTE） after head and neck malignant tumor surgery. Methods:From February 2014 to February 2020, a total of 889 patients with head and neck malignant tumor treated in the Department of Otolaryngology Head and Neck Surgery of the Third Xiangya Hospital of Central South University were selected as the research objects. 16 patients with VTE were selected as the observation group, and 30 patients were randomly selected as the control group from 873 patients without VTE. The related evaluation indexes were analyzed by univariate and multivariate logistic regression. Results:①VTE occurred in 16 cases of 889 patients with head and neck malignancy, and the incidence of VET in head and neck malignant tumor patients was 1.80%. ② Univariate analysis showed that postoperative VTE was related to gender, age, BMI, preoperative PICC, operation time and bed rest time. Multivariate logistic regression analysis indicated that age≥60 years old（OR=0.087, 95%CI: 0.012-0.643）, preoperative PICC（OR=0.133, 95%CI: 0.021-0.856） and operation time≥3 h（OR=0.119, 95%CI: 0.016-0.889） was an independent risk factor of VTE after head and neck malignant tumor operation （P<0.05）. Conclusion:VTE is a serious complication after operation for head and neck malignant tumor. The risk factors of postoperative VTE include age≥60 years, preoperative PICC and operation time≥3 h. Early prevention and timely treatment are the key to reduce postoperative VTE mortality.

Predictive value of thromboelastography for postoperative lower extremity deep venous thrombosis in gastric cancer complicated with portal hypertension patients

BACKGROUND

To explore the predictive value of thromboelastography (TEG) for the occurrence of lower extremity deep venous thrombosis (LDVT) in gastric cancer combined with portal hypertension patients after operation.

METHODS

172 gastric cancer patients combined with portal hypertension were randomly divided into laparoscopic surgery or laparotomy groups. All patients were taken venous blood on an empty stomach 1 day before operation, 1 day, 3 days, and 5 days after operation.

RESULTS

There was no significant difference in R value, K value, α angle, and MA before and after operation (P > .05). Compared with the same group before operation, the R value and K value were decreased at 1, 3, and 5 days after operation, while the α angle and MA were increased (P < .05). Compared with the non-LDVT group, the postoperative R value and K value in the LDVT group were significantly lower, while the α angle and MA were significantly higher (P < .05). The AUC of R value, K value, α angle, and MA levels at 3 days after surgery to identify patients with LDVT was 0.778, 0.718, 0.881, and 0.781, respectively. The estimated probability of the final model for LDVT was 0.622. Compared with the estimated probability ≥0.622 group, the LDVT rate in the estimated probability <0.622 group was significantly increased (χ² = 60.128, P < .001).

CONCLUSIONS

The combination of R value, K value, α angle, and MA at 3 days after surgery has a moderately effective predictive effect for the occurrence of LDVT in gastric cancer patients combined with portal hypertension.