Atrial Fibrillation/complications* ; Cardiomyopathy, Hypertrophic/complications* ; Humans ; Thromboembolism/prevention & control*

Cases of psoriasis complicated with venous thromboembolism are rarely reported. Here, we report two cases and review the current literature on the subject. Two patients with long-standing severe psoriasis presented with chest pain, shortness of breath and breathing difficulties. The patients were diagnosed using lung ventilation-perfusion scans or computed tomographic pulmonary angiography. Anticoagulation or thrombolytic therapy was initiated, and long-term continuous anticoagulation with warfarin prevented any recurrences.
Aged ; Humans ; Male ; Middle Aged ; Psoriasis ; complications ; Venous Thromboembolism ; etiology

Disease Progression ; Humans ; Neoplasms ; complications ; Venous Thromboembolism ; etiology

Lung cancer is the first leading cause of morbidity and mortality in the world. Venous thromboembolism (VTE) is a recognized complication in patients with lung cancer, which is one of the leading cause of death in lung cancer patients. The cancer-related, patient-related and treatment-related factors are the main causes of VTE in lung cancer patients. Malignant cells can directly activate blood coagulation by producing tissue factor (TF), cancer procoagulance (CP), inflammatory factors and cytokines; And the one of predominant mechanisms in cancer-related thrombosis is the overexpression of TF. The 10th edition of the antithrombotic therapy guidelines for VTE with cancer patients (AT-10) published in 2016 by American College of Chest Physicians (APCC) recommended that anticoagulant therapy is the basic treatment for patients with lung cancer complicated with VTE; And low molecular-weight-heparin (LMWH) is preferred as an anticoagulant drug, but can be use with caution due to increasing risk of bleeding.
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Anticoagulants ; pharmacology ; therapeutic use ; Humans ; Lung Neoplasms ; complications ; Risk Factors ; Venous Thromboembolism ; complications ; drug therapy

OBJECTIVE: To investigate the incidence of lower extremity deep vein thrombosis (DVT) before surgery in patients with spinal fracture and analyze its risk factors. METHODS: The clinical data of 1 046 patients with spinal fracture who underwent surgery from October 2017 to December 2020 were retrospectively analyzed, including patient's age, gender, body mass index (BMI), smoking history, complications, the time from injury to diagnosis of DVT, blood index results on admission. The complications included hypertension, osteoporosis, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), anemia, obesity, hypokalemia, hyponatremia, hypoproteinemia, renal insufficiency, spinal cord injury;blood index results on admission included hematocrit (HCT), creatinine (Cre), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein(LDL), D-dimer(D-D), fibrin/fibrinogen degradation products(FDP), and C-reactive protein(CRP). The patients were divided into group according to whether DVT was diagnosed by the lower extremity venous ultrasonography after admission to pre-operation. The patients with DVT were set as the DVT group, and the patients without DVT were set as the non-DVT group. First, the above-mentioned possible risk factors were analyzed by univariate analysis, and then the risk factors of DVT before spinal fracture surgery were analyzed by multivariate Logistic regression. RESULTS: Among 1 046 patients with spinal fracture, 137 had DVT before operation and 909 had no DVT. There were significant differences in age, the incidence of preoperative osteoporosis, diabetes, anemia, hypoalbuminemia, the levels of LDL, plasma D-D, FDP, and CRP between the two groups (P<0.05). Multivariate Logistic regression analysis showed that osteoporosis (OR=3.116, 95%CI:1.816-5.346, P<0.001), hypoproteinemia (OR=2.508, 95%CI:1.583-3.974, P<0.001), preoperative serum LDL>4.645 mmol/L(OR=2.586, 95%CI:1.394-4.798, P<0.001), plasma D-D>558.00 ng/ml (OR=23.916, 95%CI:15.108-37.860, P<0.001), FDP>13.81 µg/ml(OR=3.873, 95%CI:2.614-5.739, P<0.001) and age were independent risk factors for the occurrence of DVT before spinal fracture surgery, and the incidence of DVT in patients aged 36-50, 51-65 and over 65 years was 2.49, 2.59 and 4.02 times of those aged 18-35 years, respectively. CONCLUSION The incidence of preoperative DVT in patients with spinal fracture is 13.10%(137/1 046). Preoperative complicating osteoporosis, hypoalbuminemia, serum LDL>4.645 mmol/L, plasma D-D> 558.00 ng/ml, FDP> 13.81 µg/ml and age are risk factors for DVT. And the older the patient, the higher the risk of DVT.
Fractures, Bone/complications* ; Humans ; Hypoalbuminemia/complications* ; Incidence ; Osteoporosis/complications* ; Prevalence ; Retrospective Studies ; Risk Factors ; Spinal Fractures/surgery* ; Venous Thromboembolism

Uncontrolled or inadequately controlled postoperative pain may lead to delayed recovery from surgery, pulmonary complications, and restriction of mobility leading to increased risk of thromboembolism. Standardized regimens for pain management can lead to safer and better pain control. Of these regimens, patient-controlled analgesia, a delivery system with which patients self-administer small, predetermined analgesic doses, produced improved pain relief, greater patient satisfaction, less sedation, and fewer postoperative complications. Anesthesiologists have played an important role to make this pain management feasible. The introduction of acute pain services at hospitals prompted improvements in postoperative pain management in addition to the minimization of related complications.
Analgesia* ; Analgesia, Patient-Controlled ; Humans ; Pain Clinics ; Pain Management ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Complications ; Thromboembolism

Objective: To explore the relationship between fasting blood glucose level and thromboembolism events in patients with non-valvular atrial fibrillation (NVAF). Methods: This was an observational study based on data from a multicenter, prospective Chinese atrial fibrillation registry cohort, which included 18 703 consecutive patients with atrial fibrillation (AF) in 31 hospitals in Beijing from August 2011 to December 2018. Patients were divided into 5 groups according to status of comorbid diabetes and fasting glucose levels at admission: normal blood glucose (normal glucose group), pre-diabetes group, strict glycemic control group, average glycemic control group and poor glycemic control group. Patients were followed up by telephone or outpatient service every 6 months. The primary follow-up endpoint was thromboembolic events, including ischemic stroke and systemic embolism. The secondary endpoint was the composite endpoint of cardiovascular death and thromboembolic events. Kaplan-Meier survival analysis and multifactorial Cox regression were used to analyze the correlation between fasting glucose levels and endpoint events. Results: The age of 18 703 patients with NVAF was (63.8±12.0) years, and there were 11 503 (61.5%) male patients. There were 11 877 patients (63.5%) in normal blood glucose group, 2 023 patients (10.8%)in pre-diabetes group, 1 131 patients (6.0%) in strict glycemic control group, 811 patients in average glycemic control group and 2 861 patients(4.3%) in poor glycemic control group. Of the 4 803 diabetic patients, 1 131 patients (23.5%) achieved strict glycemic control, of whom 328 (29.0%) were hypoglycemic (fasting blood glucose level<4.4 mmol/L at admission). During a mean follow-up of (51±23) months (up to 82 months), thromboembolic events were reported in 984 patients (5.3%). The survival curve analysis of Kaplan Meier showed that the incidence rates of thromboembolic events in normal glucose group, pre-diabetes group, strict glycemic control group, average glycemic control group and poor glycemic control group were 1.10/100, 1.41/100, 2.09/100, 1.46/100 and 1.71/100 person-years, respectively (χ²=53.0, log-rank P<0.001). The incidence rates of composite endpoint events were 1.86/100, 2.17/100, 4.08/100, 2.58/100, 3.16/100 person-years (χ²=72.3, log-rank P<0.001). The incidence of thromboembolic events and composite endpoint events in the other four groups were higher than that in the normal blood glucose group (P<0.001). Multivariate Cox regression analysis showed that compared with normal glucose group, the risk of thromboembolism increased in pre-diabetes group(HR=1.23, 95%CI 1.00-1.51, P=0.049), strict glycemic control group(HR=1.32, 95%CI 1.06-1.65, P=0.013) and poor glycemic control group(HR=1.26, 95%CI 1.01-1.58, P=0.044). Conclusion: Both high or low fasting glucose may be an independent risk factor for thromboembolic events in patients with NVAF.
Aged ; Atrial Fibrillation/complications* ; Blood Glucose/analysis* ; Fasting ; Humans ; Male ; Middle Aged ; Prospective Studies ; Thromboembolism/etiology*

OBJECTIVE: To analyze the clinical characteristics of venous thromboembolism (VTE) in patients with multiple myeloma (MM) and to identify the risk factors of VTE in MM patients. METHODS: 179 newly diagnosed MM (NDMM) patients admitted to The Second Hospital of Shanxi Medical University from January 2014 to December 2020 who were followed up for more than 6 months were collected, and they were divided into VTE group and control group according to whether combined with VTE. The clinical and laboratory data were compared between the two groups. Mann-whitney U test was used for inter-group comparison of measurement data, Chi-square test or Fisher's exact test was used for inter-group comparison of count data, and multivariate logistic regression analysis was performed to explore the risk factors of VTE in MM patients. RESULTS: Compared with control group, the serum albumin (ALB) level in VTE group was significantly lower (P =0.033), the fibrinogen (FIB) level was significantly higher (P =0.016), and the proportion of patients with D-dimer≥2 000 ng/ml was significantly higher than that in the control group (26.3% vs 4.4%, P =0.002). There was a significant difference in M-component type between the two groups (P =0.028), and the proportion of IgG type in VTE group was higher. There were no statistically significant differences between two groups in age, sex, body mass index (BMI), the proportions of patients with hypertension, diabetes, coronary heart disease and cerebral infarction, white blood cell (WBC) count, platelet (PLT) count, liver and kidney function, plasma cells ratio in bone marrow, serum globulin (GLO), lactate dehydrogenase (LDH), β₂-microglobulin (β₂-MG) level, C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), prothrombin time (PT), activated partial thromboplastin time (APTT), disease stage, thrombosis prevention and the use of immunomodulators (P >0.05). Multivariate logistic regression analysis showed that FIB level (OR=1.578, 95%CI:1.035-2.407, P =0.034), D-dimer≥2 000 ng/ml (OR=5.467, 95%CI:1.265-23.621, P =0.023) and IgG type (OR=4.780, 95%CI: 1.221-18.712, P =0.025) were independent risk factors for VTE in MM patients. CONCLUSION MM patients are prone to VTE, and FIB level, D-dimer≥2 000 ng/ ml and IgG type are independent risk factors for VTE in MM patients.
Humans ; Venous Thromboembolism ; Multiple Myeloma/complications* ; Risk Factors ; Anticoagulants ; Immunoglobulin G ; Retrospective Studies

Objective: To develop a venous thromboembolism (VTE) risk assessment scale for adult burn patients and to test its reliability and validity. Methods: The scale research method and multi-center cross-sectional survey method were used. Based on the results of literature analysis method and brain-storming method, the letter questionnaire for experts was formulated. Then 27 experts (9 doctors of burn department, 9 vascular surgeons, and 9 nurses) were performed with two rounds of correspondences by Delphi method, and the reliability of the experts was analyzed. The weight of each item was determined by optimal sequence diagram method and expert importance evaluation to form the VTE Risk Assessment Scale for Adult Burn Patients. A total of 223 adult burn inpatients, who were admitted to 5 tier Ⅲ grade A general hospitals including the Affiliated Hospital of Southwest Medical University, West China Hospital of Sichuan University, the Affiliated Hospital of North Sichuan Medical College, Nanchong Central Hospital, and the Second People's Hospital of Yibin City from October 1^st 2019 to January 1^st 2020, were selected as respondents by convenience sampling method. The first assessment was performed with the VTE Risk Assessment Scale for Adult Burn Patients within 24 hours of admission of patients, and real-time assessment was performed as the patients' condition and treatment changed. The highest value was taken as the result. Correlation coefficient method and critical ratio method were used for item analysis; Cronbach's α coefficient was used to test the internal consistency of scale; content validity index was used to analyze the content validity of the scale, and receiver's operating characteristic (ROC) curve was drawn to test the predictive validity of the scale. Data were statistically analyzed with chi-square test, Pearson correlation analysis, independent sample t test, and Z test. Results: As four questionnaires in the first round of correspondence were rejected as unqualified, and another 4 experts were selected for the 2 rounds of correspondence. Most of them were aged 41 to 50 years with postgraduate degrees, engaging in the current profession for 11 to 30 years, and all of them had professional titles of associate senior or above. The scale, constructed through literature analysis, group brainstorming, and two rounds of correspondence, includes 3 primary items and 50 secondary items. In the first round of correspondence, the recovery rate of valid questionnaires and the ratio with expert opinions were 85.2% (23/27) and 47.8% (11/23), respectively. In the second round of correspondence, the recovery rate of valid questionnaires and the ratio with expert opinions were 100% (27/27) and 11.1% (3/27), respectively. The average collective authority coefficients of experts were both 0.90 in the 2 rounds of correspondence. The mean values of importance assignment, full score rate, and selection rate above 4 were 4.21, 52.5%, and 77.2%, respectively, in the first round of correspondence, and 4.28, 45.2%, and 85.8%, respectively, in the second round of correspondence. The mean coefficients of variation and the mean value of Kendall's coefficient of harmony for each item were 0.21 and 0.30 in the first round of correspondence, respectively, and 0.16 and 0.36 in the second round of correspondence, respectively. In the first and second rounds of correspondence, the Kendall's coefficients of harmony of 3 primary items (age and underlying diseases, burn injury factors, and burn treatment factors) and total secondary items were statistically significant (with χ² values of 121.46, 107.09, 116.00, 331.97, 169.97, 152.12, 141.54, and 471.70, P<0.01). The weights of primary items for age and underlying diseases, burn injury factors, and burn treatment factors were 0.04, 0.05, and 0.07, respectively. The weights of secondary items ranged from 0.71 to 0.99, with assigned values of 3 to 6. The total burn area of 223 patients ranged from 1% to 89% total body surface area, and the patients were aged from 19 to 96 years, with the risk assessment score from 0 to 98. Nine patients developed VTE, with a risk assessment score of 41 to 90. The scores of 37 items were significantly positively correlated with the total score of scale (with r values of 0.14 to 0.61, P<0.05 or P<0.01), and the items were retained. There were 36 secondary items with statistically significant differences between the patients in high-score group and low-score group (with Z values of -4.88 to -2.09, t values of -11.63 to -2.09, P<0.05 or P<0.01), and the items were retained. The total Cronbach's α coefficient of scale was 0.88. The total content validity index of scale was 0.95. The optimal threshold of the scale for the diagnosis of VTE was 40, at which the sensitivity was 88.9%, the specificity was 87.4%, the Youden index was 0.87, and the area under the ROC curve was 0.96 (with 95% confidence interval of 0.93 to 0.99, P<0.01). Conclusions: The age and underlying diseases, burn injury factors, and burn treatment factors are the risk factors for VTE in adult burn patients. The VTE risk assessment scale for adult burn patients developed based on these factors has good reliability and validity, and provide good reference value for clinical VTE risk assessment.
Adult ; Burns/complications* ; Cross-Sectional Studies ; Humans ; Reproducibility of Results ; Risk Assessment ; Venous Thromboembolism/diagnosis*

OBJECTIVE: To investigate and analyse the clinical and immunological features of patients with myositis complicated with thromboembolism. METHODS: We identified a cohort of 390 myositis patients diagnosed with myositis admitted to People's Hospital of Peking University from 2003 to 2019. The patients were retrospectively enrolled in this investigation. According to the outcome of the color Doppler ultrasound, CT pulmonary angiography, pulmonary ventilation and perfusion scan patients were divided into myositis with and without thromboembolism group. Demographic, clinical (heliotrope rash, Gottron's sign/papules, periungual erythema, skin ulceration, subcutaneous calcinosis, Mechanic's hands, myalgia, interstitial lung disease, pulmonary arterial hypertension), laboratory, immunological [anti-autoantibodies including melanoma differentiation associated gene 5 (anti-MDA5), anti-Mi-2, anti-transcription intermediary factor-1γ (anti-TIF-1γ, anti-nuclear matrix protein 2 (anti-NXP2), anti-small ubiquitin-like modifier activating enzyme (anti-SAE), anti-synthetase], imaging and therapeutic status data of the patients at the diagnosis of myositis with and without thromboembolism were collected and the differences in these data were analyzed. Logistic regressive analysis was used to identify the risk factors of thromboembolism. RESULTS: In the retrospective study, 390 myositis patients were investigated. The mean age of onset was (49.6±13.4) years, male to female ratio was 0.31 :1. Thromboembolism was identified in 4.62% (18/390) of the myositis patients, which was lower than the published reports. Out of 18 patients with thromboembolism, 55.6% (10/18) of them were deep venous thrombosis, followed by cerebral infarction (22.2%, 4/18), pulmonary embolism (11.1%, 2/18), renal artery embolism (5.6%, 1/18) and embolism of upper extremity (5.6%, 1/18). Fifty percent of thromboembolism events occurred 6 months after the diagnosis of myositis, 38.9% of thromboembolism events occurred 6 months within the diagnosis of myositis, 11.1% of thromboembolism events occurred 6 months before the diagnosis of myositis. As compared with the myositis patients without thromboembolism, the myositis patients complicated with thromboembolism were older [(58.3±11.7) years vs. (49.3±13.4) years, P=0.006]. C-reaction protein (CRP) (12.2 mg/L vs. 4.1 mg/L, P < 0.001), ferritin (20 085.5 μg/L vs. 216.6 μg/L, P < 0.001) and D-dimer (529.0 μg/L vs. 268.0 μg/L, P=0.002) were significantly higher in thromboembolism group. Diabetes (44.4% vs. 16.4%, P=0.006), coronary heart disease (22.2% vs. 3.0%, P=0.003) and surgery (16.7% vs. 3.5%, P=0.032) were observed more common in thromboembolism group than those without thromboembolism. Activated partial thromboplastin time (APTT) (26.9 s vs. 28.7 s, P=0.049) and albumin (32.4 g/L vs. 36.5 g/L, P=0.002) was lower in thromboembolism group. The risk factors of thromboembolism in the myositis patients were low level of albumin (OR=0.831, 95%CI: 0.736-0.939, P=0.003), diabetes (OR=4.468, 95%CI: 1.382-14.448, P=0.012), and coronary heart disease (OR=22.079, 95%CI: 3.589-135.837, P=0.001) were independent significant risk factors for thromboembolism in the patients with myositis. There was no significant difference in clinical manifestations, myositis-specific antibodies or myositis-associated antibodies between the two groups. CONCLUSION Thromboembolism is a complication of myositis. Lower levels of albumin, diabetes, and coronary heart disease might be risk factors of thromboembolism in myositis patients.
Adult ; Autoantibodies ; Dermatomyositis ; Female ; Humans ; Lung Diseases, Interstitial ; Male ; Middle Aged ; Myositis/complications* ; Retrospective Studies ; Thromboembolism