Tian Bo, Song Chunfeng, Li Hui, Zhang Wenqian, Chen Qirui, Chen Shuo, Fu Yili, Hu Xiaoxing, You Bin, Li Tong, Hu Bin, Hou Shengcai
Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
J Thorac Dis. 2018 Apr;10(4):2223-2230. doi: 10.21037/jtd.2018.03.174.
The high incidence of venous thromboembolism (VTE) has been perceived in post thoracic surgery patients. However, the significance of perioperative coagulation and fibrinolysis related parameters after lung surgery for VTE predicting is not clear. To investigate that, we conducted a prospective single center study.
A total of 111 patients undergoing lung surgery were enrolled in this study, included 52 primary lung cancer patients and 59 benign lung disease patients from July 2016 to March 2017. Preoperative and postoperative days 1, 3, and 5 coagulation and fibrinolysis related parameters were tested, including antithrombin (AT), fibrinogen degradation product (FDP), prothrombin time (PT), prothrombin time activity (PA), prothrombin time ratio (PR), international normalized ratio (INR), activated partial thromboplastin time (APTT), plasma fibrinogen (FBG), thrombin time (TT) and D-Dimer. The Doppler ultrasonography was performed before and after surgery for deep venous thrombosis (DVT) confirmation. Patients with new postoperative DVT, unexplained dyspnea, hemoptysis, chest pain, or high Caprini score (≥9) were received further computer tomography pulmonary angiography (CTPA) for pulmonary embolism (PE). We used the area under receiver-operating-characteristic (ROC) curve to discriminate patients between those who developed VTE and those who did not. Single factor analysis was utilized to define risk factors associated with VTE.
The overall incidence of VTE was 16.2% (18/111). The incidence of VTE in primary lung cancer patients was 23.1% (12/52), much higher than that in benign lung diseases 10.2% (6/59), but did not reach statistical significance (P=0.066). Among 18 VTE patients, 83.3% was DVT, 16.7% was DVT + PE and 72.2% was muscular veins of the calf thrombosis. D-Dimer was much higher in VTE group than that in non-VTE group preoperatively and at postoperative days 1, 3 (0.64±0.24 0.33±0.06, P=0.007; 3.14±0.75 1.51±0.09, P=0.005, and 1.88±0.53 0.76±0.05, P=0.001, respectively). And the ROC curve areas of preoperative and postoperative days 1, 3 of D-Dimer were 0.70, 0.71 and 0.74, respectively. And FDP was much higher in VTE group than that in non-VTE group at postoperative day 3 (6.78±1.43 3.79±0.15, P=0.004). But AT, PT, PA, PR, INR, APTT, FBG and TT there were no significantly difference.
The overall incidence of VTE after lung surgery was 16.2%. The patients with preoperative high D-Dimer should receive VTE prophylaxis.
胸外科手术后患者静脉血栓栓塞症（VTE）的发生率较高。然而，肺手术后围手术期凝血和纤溶相关参数对VTE预测的意义尚不清楚。为研究这一问题，我们进行了一项前瞻性单中心研究。
2016年7月至2017年3月，共有111例接受肺手术的患者纳入本研究，其中包括52例原发性肺癌患者和59例良性肺疾病患者。检测术前及术后第1、3、5天的凝血和纤溶相关参数，包括抗凝血酶（AT）、纤维蛋白原降解产物（FDP）、凝血酶原时间（PT）、凝血酶原时间活性（PA）、凝血酶原时间比值（PR）、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）、血浆纤维蛋白原（FBG）、凝血酶时间（TT）和D-二聚体。手术前后进行多普勒超声检查以确认深静脉血栓形成（DVT）。术后新发DVT、不明原因呼吸困难、咯血、胸痛或Caprini评分高（≥9分）的患者接受进一步的计算机断层扫描肺动脉造影（CTPA）以诊断肺栓塞（PE）。我们使用受试者操作特征（ROC）曲线下面积来区分发生VTE的患者和未发生VTE的患者。采用单因素分析确定与VTE相关的危险因素。
VTE的总发生率为16.2%（18/111）。原发性肺癌患者VTE的发生率为23.1%（12/52），远高于良性肺疾病患者的10.2%（6/59），但差异无统计学意义（P = 0.066）。18例VTE患者中，83.3%为DVT，16.7%为DVT + PE，72.2%为小腿肌肉静脉血栓形成。术前及术后第1、3天，VTE组的D-二聚体水平均显著高于非VTE组（分别为0.64±0.24对0.33±0.06，P = 0.007；3.14±0.75对1.51±0.09，P = 0.005；1.88±0.53对0.76±0.05，P = 0.001）。术前及术后第1、3天D-二聚体的ROC曲线下面积分别为0.70、0.71和0.74。术后第3天，VTE组的FDP水平显著高于非VTE组（6.78±1.43对3.79±0.15，P = 0.004）。但AT、PT、PA、PR、INR、APTT、FBG和TT差异无统计学意义。
肺手术后VTE的总发生率为16.2%。术前D-二聚体水平高的患者应接受VTE预防。
