Clinical Features Of Malignant Tumor Complicated With Different Thromboembolism

ObjectiveTo investigate the incidence of venous thromboembolism(VTE)in malignant tumors in our hospital for 6 years,and analyze the clinical features of malignant tumors with VTE.MethodsAmong the malignant tumor patients admitted to Henan Province People’s Hospital from April 2013 to April 2019,190 patients with perioperative VTE were selected according to the inclusion criteria.The clinical data of 190 patients were retrospectively analyzed,and the clinical data including age,gender,clinical manifestations,pathological types,TNM stages,blood routine,coagulation,lipid profile,surgery and chemotherapy were recorded.Among the 190 patients with malignant tumors,30 patients developed pulmonary thromboembolism(PTE)(PTE group),132 patients developed deep vein thrombosis(DVT)(DVT group),and 28 patients developed PTE+DVT(PTE+DVT group).To analyze the incidence and clinical characteristics of VTE in patients with malignant tumors.Results(1)The incidence of malignant tumor complicated with VTE in our hospital during the 6 years was 2.16%,accounting for 16.73% of all VTE patients.(2)Among the 190 cases of malignant tumor complicated with VTE,64.21% of the patients were under 65 years old,68.95% female,73.16% non-smoking,22.63% complicated with hypertension,61.05% underwent surgical treatment,and 48.42% had a history of chemotherapy.Moreover,there was no statistically significant difference in the basic information of each subgroup of VTE(P > 0.05).(3)Among the patients with VTE,72 cases(37.9%)had digestive system tumors,53 cases(27.89%)had lung cancer,and 40 cases(21.05%)had female reproductive system tumors.There were 15 cases of lung cancer in the PTE group(50%),11 cases of lung cancer in the PTE+DVT group(39.29%),and 55 cases of digestive system tumors in the DVT group(41.67%).Tumor TNM staging Ⅲ-Ⅳ period in 159 cases(83.68%),pathologic differentiation degree to middle and low differentiation in 163 cases(85.79%).There was no significant difference in tumor type,clinical stage and pathological differentiation between VTE subgroups(P> 0.05).(4)In VTE patients with malignant tumors,PTE occurred in 16 cases(27.59%)of the lower lobe of the right lung,11 cases(18.97%)of the double pulmonary artery,and 9 cases(15.52%)of the middle lobe of the right lung.In the PTE group,8(26.67%)patients had embolization in the lower lobe of the right lung,and in the PTE+DVT group,9(32.14%)patients had embolization in the double pulmonary artery.There was no statistically significant difference between the two groups(P > 0.05).DVT involved 62 cases of the left lower limb(38.75%),42 cases of the bilateral lower limb(26.25%)and 35 cases of the right lower limb(18.42%).The thrombus sites in the PTE+DVT group were mainly in both lower limb(28.57%),while the DVT group was mainly in the left lower limb(44.70%).The thrombus sites of the two groups were significantly different,P < 0.05.After diagnosis of VTE in tumor patients,7.89% of the patients received thrombolytic therapy and 87.37% received anticoagulant therapy.(5)The PTE group had lower MCHC and higher FIB than the PTE+DVT group;the PTE group had higher or longer HCT,HB,RBC,FIB,TT and lower MCHC than the DVT group;the PTE+DVT group had higher or longer PCT,APTT and PT than the DVT group,and the differences between the two groups were statistically significant(P < 0.05).There was no significant difference between the groups in lipid analysis(P > 0.05).(6)VTE occurred in 65.79% of patients with malignant tumors after diagnosis,57.61% after chemotherapy,and 69.83% after surgery within 3 months.Conclusions(1)Malignant tumor is the cause of the common causes of VTE,Malignant tumor mainly in the digestive system cancer,lung cancer,the female reproductive system tumor.Digestive system tumors often associated with DVT,lung cancer often associated with PTE,mainly for the middle and low degree of differentiation,TNM Ⅳ period of cancer.(2)PTE mainly involved the right lower lobe,DVT mainly involved the left lower limb,and the PTE+DVT group mainly involved both pulmonary arteries and lower limbs.The vast majority of patients were treated with anticoagulant therapy.(3)Some indicators of blood routine and coagulation function detection,such as HCT,HB,PCT,RBC,MCHC,APTT,FIB,PT and TT,may be helpful in the identification of VTE type in malignant tumors.(4)Patients with malignant tumors should be alert for the occurrence of VTE in the 3 months after diagnosis,surgery and chemotherapy.