Wang FEİ, Zhang JİAN, Gao ZHİ, Wang RONG, Li JİANXİN, Gu YONGQUAN, Wang WEİPİNG

Göğüs cerrahisi sonrasında venöz tromboembolinin risk faktörlerinin analizi: 167 olguluk klinik çalışma

Amaç: Bu çalışmada göğüs cerrahisi yapılan hastalarda venöz tromboembolinin risk faktörleri belirlendi. Çalışma planı: Eylül 2015 - Aralık 2016 tarihleri arasında göğüs cerrahisi yapılan toplam 167 hasta (107 erkek, 60 kadın; ort. yaş 56.7±16.8 yıl; dağılım 16-81 yıl) bu çalışmaya alındı. D-dimer ve C-reaktif protein değerleri incelendi ve klinik veriler kaydedildi. Hastalara ameliyat öncesi ve sonrası renkli Doppler ultrason ve toraks bilgisayarlı tomografi çekildi. Venöz tromboemboli risk faktörleri değerlendirildi. Bulgular: Hastaların 57’sinde (%34.1) göğüs cerrahisi sonrasında venöz tromboemboli gelişti ve bunların ikisinde pulmoner emboli ve diğer 55’inde derin ven trombozu izlendi. Venöz tromboemboli gelişen hastalarda yaş, D-dimer, ameliyat süresi ve vücut kütle indeksi, venöz tromboemboli gelişmeyen hastalara kıyasla, anlamlı düzeyde daha yüksekti. C-reaktif protein değerleri açısından iki hasta grubu arasında anlamlı bir fark yoktu. Yaş, sigara öyküsü, ameliyat süresi ve vücut kütle indeksi venöz tromboembolinin risk faktörleri olarak bulundu. Farklı cerrahiler arasında venöz tromboemboli insidansında anlamlı bir fark görüldü. En yüksek tromboz insidansı, özofajektomi yapılan hastalarda izlendi. Sonuç: Yaş, sigara öyküsü, ameliyat süresi ve vücut kütle indeksi venöz tromboembolinin bağımsız risk faktörleridir. Venöz tromboemboli gelişimini önlemek için özofajektomi yapılan hastalara özel ihtimam gösterilmelidir.

Analysis of risk factors for venous thromboembolism in patients after thoracic surgery: A clinical study of 167 cases

Background: This study aims to identify risk factors of venous thromboembolism in the patients undergoing thoracic surgery. Methods: A total of 167 patients (107 males, 60 females; mean age 56.7±16.8 years; range 16 to 81 years) who underwent thoracic surgery between September 2015 and December 2016 were included in this study. D-dimer and C-reactive protein values were analyzed and clinical data recorded. The patients received color Doppler ultrasound and thoracic computed tomography before and after surgery. The risk factors for venous thromboembolism were analyzed.Results: Of the patients, 57 (34.1%) developed venous thromboembolism after thoracic surgery, among whom two patients developed pulmonary embolism and another 55 developed deep vein thrombosis. Age, D-dimer, operation time, and body mass index of venous thromboembolism patients were significantly higher than non-venous thromboembolism patients. There was no significant difference in the C-reactive protein values between the two patient groups. Age, smoking history, operation time, and body mass index were found to be the risk factors of venous thromboembolism. There was a significant difference in the incidence of venous thromboembolism among different surgeries. The patients who underwent esophagectomy had the highest incidence of thrombosis. Conclusion: Age, smoking history, operation time and body mass index are independent risk factors for venous thromboembolism. A special attention should be given to the patients undergoing esophagectomy to prevent the development of venous thromboembolism.

PDF

___

25. Carrier M, Khorana AA, Moretto P, Le Gal G, Karp R, Zwicker JI. Lack of evidence to support thromboprophylaxis in hospitalized medical patients with cancer. Am J Med 2014;127:82-6.
24. Mahan CE, Fisher MD, Mills RM, Fields LE, Stephenson JJ, Fu AC, et al. Thromboprophylaxis patterns, risk factors, and outcomes of care in the medically ill patient population. Thromb Res 2013;132:520-6.
23. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:381-453.
22. Ay C, Tengler T, Vormittag R, Simanek R, Dorda W, Vukovich T, et al. Venous thromboembolism--a manifestation of the metabolic syndrome. Haematologica 2007;92:374-80.
21. Tsai AW, Cushman M, Rosamond WD, Heckbert SR, Polak JF, Folsom AR. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med 2002;162:1182-9.
20. Saluja M, Gillin21. Tsai AW, Cushman M, Rosamond WD, Heckbert SR, Polak JF, Folsom AR. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med 2002;162:1182-9.g P. Venous thromboembolism prophylaxis in urology: A review. Int J Urol 2017;24:589-93.
19. Zacho J, Tybjaerg-Hansen A, Nordestgaard BG. C-reactive protein and risk of venous thromboembolism in the general population. Arterioscler Thromb Vasc Biol 2010;30:1672-8.
18. Bakirci EM, Topcu S, Kalkan K, Tanboga IH, Borekci A, Sevimli S, et al. The role of the nonspecific inflammatory markers in determining the anatomic extent of venous thromboembolism. Clin Appl Thromb Hemost 2015;21:181-5.
17. Krieger E, van Der Loo B, Amann-Vesti BR, Rousson V, Koppensteiner R. C-reactive protein and red cell aggregation correlate with late venous function after acute deep venous thrombosis. J Vasc Surg 2004;40:644-9.
16. Auer J, Berent R, Lassnig E, Eber B. C-reactive protein and coronary artery disease. Jpn Heart J 2002;43:607-19.
15. Kelly J, Hunt BJ. A clinical probability assessment and D-dimer measurement should be the initial step in the investigation of suspected venous thromboembolism. Chest 2003;124:1116-9.
14. Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004;117:19-25.
13. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol 2008;28:370-2.
12. Oger E. Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 2000;83:657-60.
11. De Martino RR, Goodney PP, Spangler EL, Wallaert JB, Corriere MA, Rzucidlo EM, et al. Variation in thromboembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg 2012;55:1035-40.
10. Stein PD, Patel KC, Kalra NK, El Baage TY, Savarapu P, Silbergleit A, et al. Deep venous thrombosis in a general hospital. Chest 2002;122:960-2.
9. Heit JA, Silverstein MD, Mohr DN, Petterson TM, Lohse CM, O’Fallon WM, et al. The epidemiology of venous thromboembolism in the community. Thromb Haemost 2001;86:452-63.
8. Kyrle PA, Eichinger S. Deep vein thrombosis. Lancet 2005;365:1163-74.
7. Sakon M, Kakkar AK, Ikeda M, Sekimoto M, Nakamori S, Yano M, et al. Current status of pulmonary embolism in general surgery in Japan. Surg Today 2004;34:805-10.
6. Yeo DX, Junnarkar S, Balasubramaniam S, Tan YP, Low JK, Woon W, et al. Incidence of venous thromboembolism and its pharmacological prophylaxis in Asian general surgery patients: a systematic review. World J Surg 2015;39:150-7.
5. Hwang WS. The rarity of pulmonary thromboembolism in asians. Singapore Med J 1968;9:276-9.
4. Lau BD, Shaffer DL, Hobson DB, Yenokyan G, Wang J, Sugar EA, et al. Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: A randomized clinical trial. PLoS One 2017;12:e0181664.
3. Rastan AJ, Gummert JF, Lachmann N, Walther T, Schmitt DV, Falk V, et al. Significant value of autopsy for quality management in cardiac surgery. J Thorac Cardiovasc Surg 2005;129:1292-300.
2. White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost 2003;90:446-55.
1. Deitelzweig SB, Johnson BH, Lin J, Schulman KL. Prevalence of clinical venous thromboembolism in the USA: current trends and future projections. Am J Hematol 2011;86:217-20.