Gynecologic Malignancy-Associated Venous Thromboembolism and Predictive Tool at Thammasat University Hospital

Objectives: Aims were to investigate the prevalence and risk factors of venous thromboembolism (VTE) in gynecologic malignancy cases. Value of screening tool (Caprini) for prediction of VTE was also assessed. Study design: A retrospective study of gynecologic malignancy subjects who underwent major gynecological operation via exploratory laparotomy at Thammasat University Hospital, Pathum Thani, Thailand from January 2015 to December 2020. Participants were categorized into VTE and non-VTE groups. Caprini score, associated laboratory and clinical factors of both groups were evaluated. Results: A total of 392 subjects were recruited into the study. Prevalence of VTE was 7.4 (29/392) percent. VTE was diagnosed in subjects with endometrial, ovarian and cervical cancer at percentage of 7.8 (15/192), 7.9 (11/138) and 5.7 (3/53), respectively. Demographic characters of both groups were comparable. VTE group had significant more Caprini score, platelets count and platelet lymphocyte ratio (PLR) than non-VTE group. Modified Caprini score (2 multiply Caprini score plus 1 multiply PLR) was generated for better VTE prediction. Sensitivity and specificity of Caprini (≥5.5) and modified Caprini scores (≥22.8) were 72.4 vs 39.4, and 79.3 vs 52.1 percent, respectively. Conclusion: Prevalence of VTE among gynecologic malignancy cases was 7.4 percent. The modified Caprini score was an alternative VTE predictive tool. Cut-off point of modified Caprini score at equal or more than 22.8 was proposed.     

Prevalence of venous thromboembolism risk factors and prophylactic adequacy among general surgical patients in a tertiary care hospital

IntroductionVenous thromboembolism (VTE) is a disease manifested as deep vein thrombosis and pulmonary embolism. General surgical procedures are associated with significant risk of precipitating VTE, and despite the surging evidences, it is often overlooked. The study attempted at estimating the prevalence of VTE and bleeding risk factors coupled with the adequacy of thromboprophylaxis administered.MethodologyThe study spanning 1-year duration was executed through collection of data from patients older than 18 years, admitted to the general surgery department of a tertiary care hospital. The data were collected using internally validated data collection form and the appraisal of data was done using SPSS 18.ResultsAmong the 400 subjects enrolled, number of patients in low, moderate, and high risk, as per the Caprini score, was 24%, 35%, and 41%, respectively, with the difference being significant with p < 0.001. Bleeding risk was positive in 28% subjects and 36% received any form of prophylaxis other than early ambulation. 28% subjects were identified to have received adequate thromboprophylaxis.ConclusionAlthough the prevalence of 41% individuals at high risk for VTE is comparable to the global prevalence of 41.5%, prophylactic adequacy of 28% was lower than the 33% observed globally. Meticulous planning coupled with operational interventions, such as institutional multidisciplinary thromboprophylactic team, can be an effective strategy at enhancing the prophylactic standards and thereby attaining optimal patient outcomes.     

Validation of a venous thromboembolism risk assessment model in gynecologic oncology

Objectives

Gynecologic oncology patients undergoing surgery are at an increased risk for venous thromboembolism (VTE). We attempted to validate a VTE risk assessment model in gynecologic oncology patients.

Methods

All gynecologic oncology patients who underwent a laparotomy for the diagnosis or suspicion of gynecologic malignancy from 2004 to 2010 were included. Demographic, surgicopathologic, and complication data were collected. VTE was based on the symptomatic diagnosis. Data for the Caprini risk assessment model (RAM) was used to score and stratify patients on their risk for VTE.

Results

1123 gynecologic oncology patients were included within this study. Ovarian cancer was the most common diagnosis (39%) with a median age of 56.1. All patients received SCDs with 40% receiving double prophylaxis. The overall incidence of VTE was 3.3%, with lower extremity deep venous thrombosis (DVT) n = 17 and pulmonary embolism (PE) n = 20. Complication rates were similar in each group. Based on the Caprini scoring model 92% of patients scored in the “Highest Risk” category. The Caprini RAM accurately predicted all 37 VTEs, all of which scored in the “Highest Risk” category. The percentage of patients that received double prophylaxis increased with time from 12% in 2004 to 63% in 2010. Importantly, 25 of the 37 VTEs (68%) did not receive double prophylaxis.

Conclusions

The use of the Caprini RAM accurately predicted patients at the highest risk of experiencing VTE. Considering accurate identification of patients allows proper administration of double prophylaxis, we recommend the use of this scoring model preoperatively in patients undergoing surgery for gynecologic malignancies.     

Caprini血栓风险评估模型预测肺癌患者深静脉血栓形成风险的有效性研究

目的 探讨使用Caprini血栓风险评估模型预测肺癌患者深静脉血栓形成发生风险的有效性。方法 采用病例对照研究,收集承德市中心医院2014年1月至2018年12月肺癌患者中被确诊为静脉血栓栓塞症（venous thromboembolism,VTE）的100例患者作为病例组（血栓组）,并选择同时期入院的非VTE肺癌患者200例作为对照组。依据Caprini血栓风险评估量表对两组患者分别进行评分和危险度分级,比较两组患者的一般临床资料、评分情况及危险度分级的构成,采用Logistic回归模型分析Caprini风险评估量表中的危险因素以及VTE危险度分级与肺癌患者VTE发病风险的关系。结果 血栓组患者Caprini风险评分明显高于对照组,差异有统计学意义（P<0.001）;血栓组中通过Caprini风险评分量表被评定为极高危和高危的患者比例达98.0%,明显高于对照组,差异有统计学意义（P<0.001）;严重的肺部疾病,含肺炎（1个月内）、卧床的内科患者、下肢水肿、中心静脉置管、既往恶性肿瘤和深静脉血栓或肺栓塞病史等6个Caprini血栓风险评估量表中的因素是肺癌合并VTE的主要危险因素。D-二聚体、卧床的内科患者、下肢水肿、中心静脉置管、既往恶性肿瘤、深静脉血栓或肺栓塞病史是肺癌合并VTE的独立危险因素。VTE危险度分级为极高危的肺癌患者是VTE发病的高危人群,极高危肺癌患者合并VTE的发病风险是低危患者的36.573倍。结论 Caprini血栓风险评估模型能够很好地评估肺癌患者VTE的发病风险。     

骨科患者静脉血栓栓塞症分级预防方案的构建

目的 基于Caprini风险评估量表,构建骨科住院患者静脉血栓栓塞症（venous thromboembolism,VTE）的分级预防方案,为临床护理人员血栓预防工作提供科学的依据。 方法 基于循证理念进行VTE预防方案的证据总结,形成初步框架,初拟方案共包括4项一级指标、12项二级指标、49项三级指标;选取23名医生及护理人员作为函询专家,进行2轮专家函询确定分级预防方案。 结果 本研究纳入7篇指南、3篇专家共识。通过专家函询构建了包括4项一级指标、12项二级指标、39项三级指标在内的VTE分级预防方案,2轮函询专家积极系数均为100%,权威系数为0.863,肯德尔和谐系数为0.111~0.192。 结论 基于Caprini量表构建的VTE分级预防方案具有科学性,本研究结果可帮助高危科室建立VTE分级预防流程与路径,为临床护士对患者进行VTE预防提供指导依据,保障患者安全。     

三七联合现代医学常规疗法治疗脑出血术后临床研究

目的:观察三七联合现代医学常规疗法治疗脑出血术后患者的临床疗效。方法:将100例脑出血术后患者随机分成观察组和对照组各50例。2组患者均服用地奥司明片、阿司匹林肠溶片,并给予间歇充气加压装置(IPC)和常规护理措施,观察组加予三七粉鼻肠管给药。2组疗程均为7 d。治疗前、治疗7 d后评定Caprini风险评估量表评分,检测纤维蛋白原(FIB)、D-二聚体(D-D)水平;记录治疗7 d后1个月内肺栓塞(PE)和深静脉血栓(DVT)的发生情况,记录皮下瘀血、下肢肿胀、下肢疼痛的发生情况。结果:治疗后,2组Caprini评分均较治疗前下降(P<0.01),观察组Caprini评分低于对照组(P<0.01)。2组PE发生率比较,差异无统计学意义(P>0.05)。观察组DVT发生率与静脉血栓栓塞症总发生率均低于对照组(P<0.05)。观察组皮下瘀血、下肢肿胀、下肢疼痛发生率均低于对照组,但组间比较,差异均无统计学意义(P>0.05)。2组FIB、D-D水平均较治疗前下降(P<0.01),观察组FIB、D-D水平均低于对照组(P<0.01)。结论:在常规医护措施的基础上对脑出血术后患者给予三七粉鼻肠管给药,可减轻血液高凝状态和纤溶亢进状态,降低静脉血栓栓塞的发生风险。     

慢性阻塞性肺疾病急性加重病人发生肺栓塞的危险因素及 Caprini血栓风险评估量表的应用研究

目的探讨慢性阻塞性肺疾病急性加重( AECOPD)病人发生肺栓塞的危险因素及 Caprini血栓风险评估量表的应用效果。方法选择新乡医学院第一附属医院 2018年 3月至 2019年 2月 AECOPD 153例作为研究对象,收集病人的临床资料,统计肺栓塞发生情况并通过统计学分析其危险因素。所有研究对象按照是否应用 Caprini血栓风险评估量表分为两组,未评估组入院后常规临床干预,评估组接受 Caprini血栓风险评估量表评估并以此结果为指导的临床干预,比较两组的肺栓塞发生情况。结果研究中 153例 AECOPD病人发生肺栓塞 30例,发生率为 19.6%。单因素提示体质量指数(BMI)≥25 kg/m2有糖尿病史、既往静脉血栓史、有下肢水肿、卧床时间 ≥7 d、血二氧化碳分压 ≤36 mmHg、D-二聚体 ≥500 μg/L、慢性阻塞性肺疾病(、COPD)分级 >Ⅱ级的病人肺栓塞发生率更高,分别为 27.5%(22/80)、 34.1%(14/41)、 42.9%(9/21)、 44.1%(15/34)、 27.1%(23/85)、 36.0%(18/50)、 30.6%(19/62)、 28.0%(21/75),与无以上因素的病人肺栓塞发生率 11.0%(8/73)、 14.3%(16/112)、 15.9%(21/132)、     

原发性肝癌术后发生静脉血栓栓塞症的危险因素及Caprini风险预测模型的应用

目的:研究原发性肝癌术后发生静脉血栓栓塞症（venous thromboembolism,VTE）的危险因素,并验证和改良Caprini模型对肝癌术后患者VTE发生的预测能力。方法:对我院收治的452例肝癌患者进行回顾性分析,根据术后1月内是否发生VTE而分为VTE组和非VTE组。采用多因素Logistic回归以用来筛选VTE发生的独立危险因素。采用受试者操作特征曲线（receiver operating characteristic,ROC）和曲线下面积（area under ROC curve,AUC）来描述和比较传统Caprini模型和改良Caprini模型对VTE发生预测的准确性。结果:共有41例原发性肝癌患者术后出现VTE,整体发生率为9.07%。单因素分析示BMI、糖尿病患病率、门静脉癌栓发生率、手术时间、二次手术率、以及Caprini评分可能与VTE的发生有关。多因素分析示BMI（OR=1.14,P=0.01）、手术时间（OR=10.91,P=0.001）、有门静脉癌栓（OR=4.98,P=0.001）、二次手术（OR=7.85,P=0.01）和Caprini评分（OR=2.63,P=0.001）是VTE发生的独立危险因素。改良后的Caprini模型和一般Caprini模型在预测VTE时的AUC分别为0.912和0.811;当取最大约登指数时,二者敏感度分别为85.37%和63.41%,特异度分别为85.64%和87.59%。结论:BMI、手术时间、门静脉癌栓、二次手术是原发性肝癌患者术后VTE发生的独立影响因素,联合上述四种指标可以显著提高Caprini模型对VTE的预测能力。     

Caprini血栓风险评估联合集束化护理对腹腔镜下广泛性全子宫切除术病人术后下肢深静脉血栓形成的影响

目的:探讨Caprini血栓风险评估联合集束化护理对腹腔镜下广泛性全子宫切除术病人术后下肢深静脉血栓形成的影响。方法:将80例腹腔镜下广泛性全子宫切除术病人采用随机数字表法分为观察组和对照组各40例,对照组病人给予常规护理,观察组病人在对照组病人基础上给予Caprini血栓风险评估联合集束化护理,比较两组病人术后下肢深静脉血栓形成情况、术后肠胃功能恢复情况以及术后并发症。结果:干预后观察组病人的术后下肢深静脉血栓形成情况风险及发生率低于对照组(P<0.05);观察组病人肠胃功能恢复情况优于对照组(P<0.05);观察组病人术后并发症发生率低于对照组(P<0.05)。结论:Caprini血栓风险评估联合集束化护理可减少腹腔镜下广泛性全子宫切除术病人术后下肢深静脉血栓的形成,促进病人术后胃肠功能恢复,降低病人术后并发症风险和发生率,加快病人康复进程,从而提高病人生活质量。