Yu Ruidi, Nansubuga Faridah, Yang Jun, Ding Wencheng, Li Kezhen, Weng Danhui, Wu Peng, Chen Gang, Ma Ding, Wei Juncheng
Department of Obstetrics and Gynecology.
Division of Vascular Surgery, Hepatic Surgery Center, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Medicine (Baltimore). 2020 Jun 19;99(25):e20928. doi: 10.1097/MD.0000000000020928.
In this study, we investigate the incidence of venous thrombosis (VT), and evaluate the effectiveness and safety of 3 major thromboprophylaxes and the potential risk factors for VT in women undergoing surgery for a gynecological malignancy.
We performed a randomized controlled trial of 307 patients undergoing laparoscopic surgery for gynecological malignancies at a single institution from January 2016 to October 2017. Patients were divided into 3 groups: one receiving a half dose of low-molecular-weight heparin sodium injection (FLUXUM, Alfa Wassermann, Italy) delivered by injection, one receiving a full dose of FLUXUM, and a third group receiving an Argatroban injection.
None of the patients in our study developed a pulmonary embolism, bleeding, or infectious complications. There were no statistical differences in the rate of deep venous thrombosis (DVT) (0%, 0%, and 2.38%) and the superficial venous thromboembolism (SVT) (15.66%, 8.97%, and 18.6%) among the 3 groups. None of the patients developed symptomatic VT. The effect of treatment on alanine aminotransferase and aspartate aminotransferase differed between the groups, with a minimal effect in the Argatroban group, and all 3 methods resulted in minimal impairment of renal function. Decreased hemoglobin, elevated levels of D-dimer, and prothrombin time were closely related to thrombogenesis.
In conclusion, the incidence of postoperative thrombosis in gynecological malignancy among these Chinese people is not as low as we had originally presumed. Argatroban is not more effective than Parnaparin as a direct thrombin inhibitor, but it has less influence on liver function, which is beneficial for patients undergoing chemotherapy. Hemoglobin, D-dimer, and prothrombin time may be used to predict or detect thrombogenesis.
在本研究中，我们调查了静脉血栓形成（VT）的发生率，评估了三种主要血栓预防措施的有效性和安全性，以及妇科恶性肿瘤手术女性发生VT的潜在危险因素。
2016年1月至2017年10月，我们在一家机构对307例接受妇科恶性肿瘤腹腔镜手术的患者进行了一项随机对照试验。患者分为三组：一组接受注射半剂量低分子量肝素钠注射液（FLUXUM，意大利阿尔法·瓦瑟曼公司），一组接受全剂量FLUXUM，第三组接受阿加曲班注射液。
我们研究中的患者均未发生肺栓塞、出血或感染并发症。三组之间深静脉血栓形成（DVT）率（0%、0%和2.38%）和浅静脉血栓栓塞（SVT）率（15.66%、8.97%和18.6%）无统计学差异。所有患者均未发生症状性VT。治疗对丙氨酸转氨酶和天冬氨酸转氨酶的影响在各组之间有所不同，阿加曲班组影响最小，所有三种方法对肾功能的损害均最小。血红蛋白降低、D-二聚体水平升高和凝血酶原时间与血栓形成密切相关。
总之，这些中国人妇科恶性肿瘤术后血栓形成的发生率并不像我们最初设想的那么低。阿加曲班作为直接凝血酶抑制剂并不比帕肝素更有效，但对肝功能的影响较小，这对接受化疗的患者有益。血红蛋白、D-二聚体和凝血酶原时间可用于预测或检测血栓形成。
