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1.
目的:对比分析低分子量肝素钙与阿哌沙班预防老年髋部周围骨折患者围手术期深静脉血栓形成(DVT)的疗效性及安全性。方法:收集2018年3月-2020年3月在山西省中医院骨科行手术治疗的老年髋部周围骨折患者共70例,按随机数字表法分为A组(低分子量肝素钙组)和B组(阿哌沙班组),各35例;A组皮下注射低分子量肝素钙 0.4mL Qd,B组口服阿哌沙班 2.5mg Bid。两组术后持续抗凝35天,随访3月,比较两组凝血指标、术后引流量、围手术期DVT及出血事件发生率。结果:(1)两组患者术后与术前相比,PLT、D-二聚体下降,APTT、PT延长,且B组D-二聚体较A组明显下降,相比差异有统计学意义(P<0.05),而两组APTT、PT、PLT相比差异无统计学意义(P>0.05);(2)两组术后引流量(A组:170.86±126.40mL,B组:175.71±141.39mL)相比差异无统计学意义(P>0.05);(3)两组患者围手术期DVT发生率对比差异有统计学(P<0.05),其中A组发现DVT患者9例(25.7%),B组发现DVT患者2例(5.7%);(4)两组患者出血事件发生率相比差异无统计学意义(P>0.05)。结论:与低分子量肝素钙相比,老年髋部周围骨折患者围手术期使用阿哌沙班预防DVT的疗效更佳,且不增加出血风险。  相似文献   
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3.

Objective

To evaluate the effect of hospitalization on deep venous thrombosis (DVT) rate by the cumulative incidence of DVT in the proximal venous tract of the lower limbs at admission and discharge.

Methods

The AURELIO (rAte of venoUs thRombosis in acutEly iLl patIents hOspitalized in internal medicine wards) multicenter observational study was carried out in hospital-university internal medicine wards including consecutive acutely ill medical patients. Patients underwent compression ultrasonography (CUS) of proximal lower limb veins at admission and discharge. The occurrence of DVT was the primary end point of the study.

Results

Among 1340 patients, 26 (1.9%; 95% CI, 1.3%-2.8%) had asymptomatic DVT at admission and were excluded. During the follow-up, 144 patients were excluded because of hospitalization less than 5 days. The remaining 1170 patients underwent a CUS at discharge. Two hundred fifty (21%) underwent prophylaxis with parenteral anticoagulants; the remaining 920 (79%) were not treated with anticoagulants. The mean length of hospitalization was 13±8 days. Compared with patients without prophylaxis, those treated with parenteral anticoagulants had a higher incidence of active cancer, heart and respiratory failure, pneumonia, renal failure, previous venous thromboembolism, reduced mobility, and elderly age. During the hospital stay, 3 patients with a negative CUS at admission experienced DVT in the proximal tract (0.025%, rate of 1 per 5017 patient-days); 2 of them were in prophylaxis with parenteral anticoagulants.

Conclusion

We provide evidence that in the real world acutely ill medical patients display more than 90% (1.9%) asymptomatic DVT at admission, whereas the intrahospital DVT occurrence is very low. This suggests a novel diagnostic workup and a careful reanalysis of anticoagulant prophylaxis.  相似文献   
4.
IntroductionThere is a high post-operative incidence of venous thromboembolisms (VTEs), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), in pelvic ring and acetabular fractures, and identification of risk factors for VTEs is crucial to decrease this highly morbid complication. High altitudes have a known physiological effect on the body that may predispose patients to developing VTEs in the postoperative period. The purpose of this study was to investigate the relationship between pelvic ring and acetabular fractures occurring at high altitudes and the development of postoperative VTEs.MethodsIn this retrospective study, the Truven MarketScan claims database was used to identify patients who underwent surgical fixation of a pelvic ring and/or acetabular fracture from January 2009 to December 2018 using Current Procedural Terminology (CPT) codes. Patient characteristics, including medical comorbidities, were collected. The zip codes of where the surgeries took place were used to determine recovery altitude and patients were separated into either the high altitude (>4000 feet) or low altitude (<100 feet) cohorts. Chi-squared and multivariate analyses were performed to investigate the association between altitude and the development of VTE postoperatively.ResultsIn total, 68,923 patients were included for analysis. At 30-days postoperatively, a higher altitude was associated with increased odds of developing a PE (OR 1.47, p = 0.019). At 90-days postoperatively, a higher altitude was associated with increased odds of DVT (OR 1.24, p = 0.029) and PE (OR 1.63, p < 0.001).ConclusionSurgical fixation of pelvic ring and acetabular fractures performed at a higher altitude (>4,000feet) are associated with increased odds of developing a PE in the first 30 days as well as developing a DVT or PE at 90 days postoperatively. Future prospective studies are needed to further elucidate the causality of altitude on the development of postoperative VTEs.  相似文献   
5.
《中国现代医生》2019,57(11):75-78+81
目的探讨血栓弹力图、D-二聚体在妊娠高危高凝抗凝治疗终点并发DVT患者中的预测效果。方法取2016年1月~2017年4月医院收治的孕20~40周妊娠高血压孕妇90例,设为妊娠高危组;取同期入院普通孕妇60例,设为正常对照组。均给予血栓弹力图分析仪对两组进行评估;采用散色比浊法测定两组D-二聚体(Ddimer,D-D)水平。妊娠高危组根据评估结果分为高血压组(n=78)和高血压用药组(n=12)。高血压组不采取措施处理,高血压用药组采用阿司匹林抗凝处理,利用血栓弹力图分析仪再次对患者进行评估并完成D-D水平的测定,分析血栓弹力图、D-二聚体在妊娠高危高凝抗凝治疗终点并发DVT患者中的预测效果。结果高血压用药组血块动力(K)低于高血压组(P0.05);高血压用药组凝血指数、血块强度、D-D水平均高于高血压组(P0.05);妊娠高危高凝抗凝治疗终点并发DVT预测效能较好指标依次为:Alpha、MA及CI联合D-二聚体,诊断敏感性、特异性均相对较高。结论血栓弹力图中Alpha、MA及CI联合D-二聚体能预测妊娠高危高凝抗凝治疗终点并发DVT情况,能指导临床治疗,值得推广应用。  相似文献   
6.
《The Journal of arthroplasty》2022,37(5):958-965.e3
BackgroundVenous thromboembolism (VTE) is a potential postoperative complication after total hip arthroplasty (THA). These events present with a range of severity, and some require readmission. The present study aimed to identify unexplored risk factors for severe VTE that lead to hospital readmission.MethodsThe Agency of Healthcare Research and Quality’s National Readmissions Database was retrospectively queried for all patients who underwent primary THA (January 2016 to December 2018). Study population included patients who were readmitted for VTE within 90 days after an elective THA. Bivariate and multivariate regression analyses were performed using patient demographics, insurance status, elective nature of the surgery, healthcare institution characteristics, and baseline comorbidities.ResultsHigher risk of readmission for VTE was evident among elderly (71-80 years vs <40 years: odds ratio [OR] 1.7, 95% confidence interval [CI] 1.3-2.2, P = .0002), male patients (OR 1.2, 95% CI 1.2-1.3). Nonelective THAs were associated with markedly higher odds of readmission for VTE (OR 20.5, 95% CI 18.9-22.2), peripheral vascular disease (OR 1.2, 95% CI 1.1-1.4), lymphoma (OR 1.5, 95% CI 1.1-2.1), metastatic cancer (OR 1.8, 95% CI 1.4-2.2), obesity (OR 1.5, 95% CI 1.4-1.6), and fluid-electrolyte imbalance (OR 1.1, 95% CI 1.0-1.2). Home health care (OR 0.8, 95% CI 0.7-0.8) and discharge to skilled nursing facility (OR 0.7, 95% CI 0.7-0.8) had lower odds of readmission for VTE vs unsupervised home discharge, while insurance type was not a significant driver(P > .05).ConclusionOne in 135 THA patients is likely to experience a VTE requiring readmission after THA. Male patients, age >70 years, and specific baseline comorbidities increase such risk. Furthermore, discharge to a supervised setting mitigated the risk of VTE requiring readmission compared to unsupervised discharge. As VTE prophylaxis protocols continue to evolve, these patients may require optimized perioperative care pathways to mitigate VTE complications.  相似文献   
7.
A retrospective analysis of endovenous glue-closure therapy (EVGC) performed in 76 greater saphenous veins (GSVs) from February 2016 to December 2017 was conducted to assess the incidence and characteristics of endovenous glue-induced thrombosis (EGIT), a phenomenon unique to nonthermal EVGC for GSV insufficiency. Kabnick and Lawrence classifications for endovenous heat-induced thrombosis were adopted. Seven instances of EGIT were detected among 54 patients (13%), with median/mode Kabnick and Lawrence classifications of 2/2 and 4/5, respectively. EGIT resolved with observation within an average of 5.2 wk after detection (range, 2–8 wk) without deep vein thrombosis or pulmonary embolism. EGIT was associated with significantly greater mean age (+7.75 y; P = .0308).  相似文献   
8.
目的:比较利伐沙班与低分子肝素预防膝关节翻修术后深静脉血栓(Deep Vein Thrombosis,DVT)的临床疗效。方法:回顾分析2014年1月—2017年1月收治的58例(59膝)膝关节翻修患者的临床资料,按 DVT预防方式分为低分子肝素组33例(33膝)和利伐沙班组25例(26膝),采用SPSS19.0统计软件进行分析,比较两组患者术后DVT及出血事件的发生率和膝关节疼痛、肿胀、淤血瘀斑、功能以及不良事件发生率的差异。结果:术后患者切口均Ⅰ期愈合,利伐沙班组和低分子肝素组DVT的发生率为分别为4.00%(1/25)和6.06%(2/33),两组差异无统计学意义(P>0.05)。利伐沙班组皮下瘀斑的发生率为36.00%(9/25),显著高于低分子肝素组6.06%(2/33),差异有统计学意义(P<0.05)。两组患者术后引流量、出凝血指标、肢体肿胀程度及膝关节HSS(Hospital for Special surgery knee Score)评分、VAS(Visual Analogue Score)疼痛评分、不良事件的发生率均无统计学差异(P>0.05)。结论:利伐沙班和低分子肝素预防膝关节翻修术后DVT安全有效,二者效果相当,但利伐沙班增加了皮下瘀斑形成的风险。  相似文献   
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10.

Purpose

Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism, is a common cause of morbidity and mortality after radical cystectomy. The purpose of our study was to evaluate the utility of extended outpatient chemoprophylaxis against VTE after radical cystectomy—with a focus on any reduction in the incidence of VTE, including DVT and pulmonary embolism.

Materials and methods

Beginning in April 2013, we prospectively instituted a policy of extending inpatient VTE prophylaxis with subcutaneous heparin/enoxaparin for 30 days postoperatively. For this study, we reviewed the electronic medical records of all patients who underwent radical cystectomy at our institution from January 2012 through December 2015. The experimental group (n = 79) received extended outpatient chemoprophylaxis against VTE; the control group (n = 51) received no chemoprophylaxis after discharge. The primary outcome was the 90-day incidence of VTE. The secondary outcomes included the overall complication rate, the hemorrhagic complication rate, as well as the rate of readmission within 30 days of hospital discharge.

Results

The experimental group experienced a significantly lower rate of DVT (5.06%), assessed as of 90 days postoperatively, than the control group (17.6%): a relative risk reduction of 71.3% (P = 0.021). We found no significant differences in secondary outcomes between the 2 groups, including the overall complication rate (54.4% vs. 68.6%), the hemorrhagic complication rate (3.7% vs. 2.0%), and the readmission rate (21.5% vs. 29.4%).

Conclusion

Extended outpatient chemoprophylaxis significantly reduced the incidence of VTE.  相似文献   
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