Risk Factors For Lung Cancer With Venous Thromboembolism And The Application Of Prophylactic Anticoagulation

Venous thromboembolism is a common complication of malignant tumors,and as the highest incidence of malignant tumors in our country,lung patients has attracted highly attetion.A number of studies both at home and abroad suggest that venous thrombosis is closely related to the treatment and prognosis of lung cancer.Lung cancer patients with venous thromboembolism have a poor prognosis and higher mortality,while prophylactic anticoagulation therapy may reduce the risk of thrombosis.Thus,understanding high risk factors and high incidence period of lung cancer patients with venous thromboembolism and achieving early prevention,early diagnosis and early treatment has important clinical significance.?Objective?To analyze the clinical features of lung cancer patients with venous thromboembolism,to find out the risk factors of VTE in lung cancer patients,and to improve the prevention and diagnosis awareness in high-risk patients.To observe the application of prophylactic anticoagulation in lung cancer patients and compare the changes of laboratory indexes before and after prophylactic anticoagulation therapy to understand the relative risk and necessity of anticoagulation therapy.?Methods?A retrospective analysis of Shanghai Changhai Hospital from June 2012 to June2016 of total 2325 cases of lung cancer patients admitted to the selected patients with complete medical records of 50 patients with venous thrombosis in the observation group(VTE group)were analyzed venous thrombosis occurence time,treatment and clinical outcome.According to the ratio of 1: 2,100 common lung cancer patients who were randomly assigned to hospital for admission but did not have venous thrombosis were selected as controls(None-VTE group).General conditions(including age,sex,combined disease,smoking history),tumor-related status(including lung cancer pathology,TNM staging and treatment),laboratory tests(including coagulation,white blood cell count,hemoglobin and blood lipids),whether prophylactic anticoagulation or not of the two groups were analyzed.47 patients who started prophylactic anticoagulation in the 150 patients were enrolled as the research object.The patients' coagulation function,white blood cell count and hemoglobin at this and next admission were recorded.SPSS 21.0statistical software was used for all data to process and analyze the results statistically,test level ?=0.05,difference with p<0.05 was statistically significant.?Results?The incidence of venous thromboembolism in lung cancer within 6 months after diagnosis reached up to 78%,with deep venous thrombosis and pulmonary thromboembolism most common.The results of univariate analysis showed that D-dimer,WBC and PT of patients with venous thromboembolism were significantly higher than those of the control group(P <0.05).The incidence of venous thromboembolism in patients with lung adenocarcinoma,IIIb-IV staging,patients receiving radiotherapy and chemotherapy was significantly higher than that of patients without venous thromboembolism(P <0.05).The incidence of venous thromboembolism in patients with prophylactic anticoagulation was significantly lower than that in patients without prophylactic anticoagulation(12.8% vs 47.7%,P <0.001).Multivariate regression analysis showed that elevated levels of adenocarcinoma,chemotherapy,and abnormal coagulation D-dimer were independent risk factors for pulmonary embolism in patients with lung cancer(P <0.05),whereas prophylactic anticoagulation therapy could reduce lung cancer The incidence of VTE in patients was 12.8% vs 47.7%(P <0.001).In patients with prophylactic anticoagulant,D-dimer decreased significantly compared with the previous,statistically significant difference(P <0.05),prothrombin time,partial prothrombin time,fibrinogen,white blood cell count,hemoglobin,etc.There is no statistical difference between the indicators.?Conclusion?Lung cancer patients with adenocarcinoma,,D-dimer,and receiving chemotherapy is a risk factor for VTE,lung cancer within 6 months after diagnosis is the high occrurrence time of VTE,prophylactic anticoagulation can significantly reduce lung cancer patients D-dimer levels to effectively reduce the incidence of VTE in patients with lung cancer,and pre-other indicators of coagulation and white blood cells,hemoglobin,etc.had no significant effect,which did not increase the risk of bleeding in patients.Clinically,it is necessary to be vigilant to patients with the above risk factors and in the high incidence period,to actively give preventive treatment and to reduce the incidence of venous thrombosis.