Clinical Study Of Hypercoagulable State With Venous Thrombosis During The Perioperative Of Lung Carcinoma In Thoracic Surgery Department

Object: The aim of this study was to seek feasible clinical evidences of preventing and anti-coagulation VTE,and reduce the perioperative mortality.We investigated the incidence of VTE,the laboratory bio-markers characters of hypercoagulable state and the risk factors in lung carcinoma patients postoperative period who underwent surgery in Thoracic Surgery Department,SiChuan Provence Cancer Hospital.Method: We recruited patients with lung carcinoma admitted to the same medical group in the Department of Thoracic Surgery,SiChuan Provence Cancer Hospital from March 2015 to August 2016.We analyzed the relationship between the risk factors and the occurrence of DVT,and tested the laboratory bio-markers perioperative.At the same time,we summarized the characters of hypercoagulable state.We compared the difference of laboratory bio-markers between VTE(+)group and VTE(-)group.We evaluated the applicability of the Caprini and Rogers Thrombosis Risk Assessment Scale in these patients.Result:153 patients were admitted preoperative and 144 patients were admitted postoperative.The incidence of DVT was 1.96%(3/153)preoperative and the incidence of DVT was 23.6%(34/144)postoperative,none was PE.The detection rate of DVT during postoperative day(POD)3-7 was 76.5%.Compared with the DVT(-)group,age(62.3 ±8.9 vs.57.7 ± 9.8),duration time of operation(220.2±91.6vs.161.5±90.6min),time in bed(5.0 ± 4.8 vs.3.7 ± 2.0 days),drainage tube retention time(7.0 ± 4.0 vs.5.9 ± 3.2 days),hospitalization time(13.5± 5.8 vs.10.0 ± 4.0 days)of the DVT(+)group were longer(p<0.05).Univariate analysis showed that COPD,non-O blood,traditional thoracotomy,duration time of operation? 90 min,time in bed> 72 h,squamous cell carcinoma,advanced tumor were high risk factors of DVT.Multivariate analysis displayed that COPD(OR: 53.793,95%CI:3.58-808.05,p=0.004),? stage(OR: 8.803,95% CI: 1.809-42.837,p=0.007),duration time of operation?90min(OR:0.562,95%CI:1.510-20.485,p=0.01),non-O blood type(OR:4.231,95%CI:1.126-15.892,p=0.033)were independent risk factors of DVT.Compared with the DVT(-)group,the laboratory bio-markers of the DVT(+)group such as TP(52.5±6.5 vs.55.4±7.1g/l),Glu(8.4±2.7 vs.7.4±1.6g/l),FDP(9.1±10.6 vs.5.6±6.7mg/l),D-Dimmer(2.6±3.6 vs.1.5±2.0ug/l)POD1,and RBC(3.5±0.5 vs.3.8±0.6×10^9/L),CRP(118±63.4 vs.98.0±56.6ug/L),FDP(17.6±28.3 vs.7.6±17.8mg/L),D-Dimmer(4.0±5.4 vs.1.9±3.3ug/L)POD3,APTT(29.8±7.1 vs.32.3±5.3seconds),TT(15.5±1.2 vs.14.9±2.0seconds)POD7 were significant different(p<0.05).Compared with the laboratory bio-markers preoperative,PT was prolonged during POD1-3 and returned topreoperative state on POD7,APTT as prolonged during POD3-7,the level of FIB,FDP,D-dimer increased during POD1-7.The incidence of DVT in the high-risk group and the very high-risk group categorized by Caprini venous thromboembolism risk assessment scale was 20.9% and26.0%(p= 0.474).All patients were faced very high risk factor categorized by Rogers venous thromboembolism risk assessment scale.Conclusion: The incidence of VTE perioperative was high in patients with lung carcinoma of the Department of Thoracic Surgery and we should pay more attention.The VTE often occurred during POD3-7.Duration time of operation,time in bed postoperative,COPD,blood type,surgical method,pathological type,tumor stage were risk factors of VTE.At present,the patients are hypercoagulable after surgery and the VTE predictors of laboratory bio-markers are still lacked.Although both the Caprini and Rogers Thrombosis Risk Assessment Schedules advise that these patients with lung carcinoma underwent pneumonectomy faced a high risk of VTE,but they can't assess the incidence of VTE accurately.