Wang Pan, Zhao Honglin, Zhao Qingchun, Ren Fan, Shi Ruifeng, Liu Xingyu, Liu Jinghao, Liu Hongyu, Chen Gang, Chen Jun
Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
Cancer Manag Res. 2020 Jun 30;12:5169-5179. doi: 10.2147/CMAR.S256484. eCollection 2020.
The incidence of venous thromboembolism (VTE) is higher in patients with lung cancer. The aim of this study was to investigate the risk factors associated with postoperative VTE and explore the VTE predication capacity of D-dimer kinetics.
Six hundred patients who had lung tumor surgery were analyzed retrospectively between January 2018 and August 2019, and venous ultrasound imaging and D-dimer examination before and after surgery were recommended to all operative patients. Of these 600 patients, 523 patients had venous thromboembolism after surgery, and 77 patients had not found. The general clinical data, postoperative prophylactic anticoagulant therapy, early systemic thromboprophylaxis, 50% increment of D-dimer, 100% increment of D-dimer, and perioperative (preoperative and days 1, 3, and 5 after surgery) D-dimer levels were collected. Logistic regression analysis was used to analyze the independent risk factors of postoperative VTE.
VTE developed in 77 (12.8%) patients. In a univariate analysis, age, surgical approach, tumor size, histology, postoperative preventive anticoagulation, postoperative limb compression therapy, postoperative hemostasis, duration of operation, early systemic thromboprophylaxis, 100% increment of D-dimer, preoperative and postoperative D-dimer level, intraoperative blood loss, and time spent in the hospital were significantly different between the thrombus group and nonthrombus group ( < 0.05). Multivariate analysis showed that age >60 years ( = 0.006) and D-dimer level on 5 days after surgery ( = 0.000) were significant independent risk factors for VTE. Postoperative D-dimer was significantly higher than the preoperative level ( < 0.001). Postoperative D-dimer level was significantly different between benign and malignant tumor groups ( < 0.05) and between the thrombus group and nonthrombus group ( < 0.001). Preventive anticoagulation and limb compression therapy starting from the first day after surgery was statistically significant between the thrombus group and the nonthrombus group ( < 0.05).
Continuous detection of D-dimer level after pulmonary tumor surgery combined with thrombotic-related risk factors can better evaluate the occurrence of VTE. Preventive anticoagulant therapy and limb compression therapy starting from the first day after surgery can effectively reduce the incidence of VTE.
肺癌患者静脉血栓栓塞症（VTE）的发生率较高。本研究旨在探讨与术后VTE相关的危险因素，并探索D-二聚体动力学对VTE的预测能力。
回顾性分析2018年1月至2019年8月期间600例行肺肿瘤手术的患者，并建议所有手术患者术前行静脉超声成像及D-二聚体检查。在这600例患者中，523例术后发生静脉血栓栓塞，77例未发现。收集患者的一般临床资料、术后预防性抗凝治疗、早期全身血栓预防、D-二聚体升高50%、D-二聚体升高100%以及围手术期（术前及术后第1、3、5天）D-二聚体水平。采用Logistic回归分析术后VTE的独立危险因素。
77例（12.8%）患者发生VTE。单因素分析显示，血栓组与非血栓组在年龄、手术方式、肿瘤大小、组织学类型、术后预防性抗凝、术后肢体压迫治疗、术后止血、手术时间、早期全身血栓预防、D-二聚体升高100%、术前及术后D-二聚体水平、术中出血量及住院时间等方面差异有统计学意义（<0.05）。多因素分析显示，年龄>60岁（=0.006）及术后第5天D-二聚体水平（=0.000）是VTE的显著独立危险因素。术后D-二聚体明显高于术前水平（<均数差0.001）。良性与恶性肿瘤组术后D-二聚体水平差异有统计学意义（<均数差0.05），血栓组与非血栓组术后D-二聚体水平差异有统计学意义（<均数差0.001）。术后第1天开始的预防性抗凝和肢体压迫治疗在血栓组与非血栓组之间差异有统计学意义（<均数差0.05）。
肺肿瘤手术后持续检测D-二聚体水平并结合血栓形成相关危险因素，可更好地评估VTE的发生情况。术后第1天开始进行预防性抗凝治疗和肢体压迫治疗可有效降低VTE的发生率。
