| Objective : To study the influencing factors of venous thromboembolism in perioperative patients with non-small cell lung cancer.Evaluate the safety and efficacy of different dosages of enoxaparin in the prevention of VTE in this patients.To provide evidence-based evidence for the clinical prevention of VTE in perioperative patients with non-small cell lung cancer in the future.Method:A total of 113 patients scheduled for pulmonary surgery were randomlyassigned to high-dose group(6000u once daily)and low-dose group(3000u once daily)in the same thoracic surgery form June 2016 to December 2017.The caprini assessment scale was used to assess the thrombotic risk,and the assessment of risk factors for major bleeding complications in surgical inpatientswas used to assess thebleeding risk in this patients.We observed the occurrence of VTE in patients from 4 detection points(Preoperative 3th days,postoperative 3th Days,postoperative 7th Days,postoperative 30 ± 3th Days).Analysis of the changes with blood routine,biochemicaland coagulation function related indexes were based from 5 detection points(Preoperative 3th days,postoperative 1th Days,postoperative 3th Days,postoperative 7th Days,postoperative 30±3th Days).We counted and analyzed the incidence of VTE,clinical risk factors and the changes in hematological indexes in perioperative patients after receiving the treated with enoxaparin.Result:1.A total of 113 patients were included in this study.55 patients received enoxaparin 6000 u daily(high-dose group),58 received 3000 u daily(low-dose group).The patients were well matched at baseline for demographic variablesbetween the high dose group and low dose group.There were no significant differences in general clinical data and preoperative hematological indexesbetween the two groups.In addition,the Caprini score was between 0-5 points at preoperative point,2.19 + 1.17 points in average.And the postoperative Caprini score was 5-9 points,5.79±1.02 points in average.2.A total of 12 patients developed VTE,the incidence of which was 10.6%.There were 19 sites of VTE,which were all deep vein thrombosis(DVT)of the lower extremity,and no pulmonary embolism was developed.Among them,there were 17(89.47%)leg venous thrombosis and 2 femoral vein(10.53%).All DVT were found within postoperative 7th Days.The average time was 5.67 + 1.97 days,and the average size of thrombus was 9.14 + 10.17 mm.There was significant difference in the incidence of VTE between the two groups(3.64% vs.17.24% p=0.019).3.There was no significant difference in postoperative caprini score between high-dose group and low-dose group.There was no major bleeding riskafter surgery and no situation after enoxaparin treatment,such as,bleeding,coagulation dysfunction,unexplained thrombocytopenia,and abnormal liver and kidney function,in the two groups.The D-dimer and fibrinogen degradation product of patients increased first and then decreased gradually in the two groups.There was significant difference in trend with temporal variation of above indexes between the two groups.(p=0.004;p=0.005),and no significant difference in other indexes(P>0.05).4.We found that the incidence of VTE associated with the age of patients> 60 years old,postoperative bed time>48h,high Caprini score and distant metastasis of cancer in the patients.Multifactor analysis showed that the Over 60-year-old patientshad nearly a 8.921-fold greater VTE risk than who under the age of 60(OR:8.921,95%CI: 1.794-44.346,p=0.007).Patients with perioperative prophylaxis with 3000 u enoxaparin had a 6.37-fold higher risk of VTE than those with 6000 u enoxaparin(OR:6.353,95%CI:1.246-31.921,p=0.025).5.There was a significant increase in preoperative and postoperative caprini scores with patients in the VTE(+)group(3.42±1.08 vs.2.04±1.09 p=0.000;6.92±1.16 vs5.65±0.92 p=0.000,compared with the VTE(-)group).The erythrocytes and hemoglobin of patients with VTE(+)were less than the VTE(-)patients(P < 0.05)in the postoperative 3th Days.The platelets,D-dimer and fibrinogen degradation product of patients with VTE(+)were more than the VTE(-)patients in the all detection points(P < 0.05).There was significant difference in trend with temporal variation of above indexes between the two groups.Conclution1.The incidence of VTE in patients with non-small cell lung cancer in the perioperative period was extremelyhigh.The Caprini scores were equal to or more than 5 points after the operation.In principle,all patients were required to drug treatment(such as enoxaparin)combining with physical interventions(such as IPC)to prevent VTE.2.Enoxaparin for the prevention of perioperative VTE in patients with non-small cell lung cancer who are not in risk of hemorrhageis safe and effective.3.The study showed that the daily dose of enoxaparin 6000 u is safe and feasible.It can significantly reduce the perioperative incidence of VTE in non small cell lung cancer patients and the effect is better than given daily doses of 3000 u.4.The patients with Caprini score in high-risk(≥5 points) and tumor metastasis should be given preventive intervention. |
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