Analysis Of Risk Factors And Thrombelastography Value Of Postoperative Venous Thromboembolism In Patients With Lung Cancer

Objective:To analyze the risk factors and laboratory characteristics of postoperative venous thromboembolism（VTE）in patients with lung cancer,and to explore the risk factors,the predictive value of thrombelastography and related test indexes in postoperative VTE in patients with lung cancer.Methods:According to the inclusion and exclusion criteria,227 patients with lung cancer who underwent surgery in the First Bethune Hospital of Jilin University from December 2020 to October 2021 were enrolled.The general clinical data,operation and tumor related data,perioperative coagulation index,hematological index and biochemical index of all patients were collected.The incidence of postoperative VTE in patients with lung cancer after operation was analyzed.Compare the differences of the above data between patients with and without venous thromboembolism by relevant statistical methods.Use multivariate logistic regression to analyze the independent risk factors of postoperative VTE in patients with lung cancer.The receiver working curve was used to evaluate the predictive value of the above collected data for postoperative venous thromboembolism in patients with lung cancer,and the best diagnostic threshold was selected by Youdan index to predict the occurrence of venous thromboembolism,so as to provide scientific basis for clinical prediction of postoperative venous thromboembolism.Results:（1）A total of 63 of the 227 patients developed postoperative venous thromboembolism,with an incidence of 27.75%.（2）There were significant differences in age,FEV1,preoperative Pa O2,PICC intubation,ESR,glycosylated hemoglobin,operation duration,intraoperative blood loss and blood transfusion between patients with postoperative venous thromboembolism and those without venous thromboembolism（P<0.05）.The postoperative thrombelastography parameters,such as the reaction time R,clot formation time K,clot formation rate α,maximum amplitude MA and coagulation index CI,were significantly different between patients with and without VTE（P < 0.05）.There was no significant difference in blood lipid,homocysteine and other related risk factors of arterial thromboembolism in the above-mentioned patients（P>0.05）.（3）Multivariate logistic regression analysis showed age（OR=1.113;95%CI:1.027-1.205）,the reaction time R（OR= 0.353;95% CI: 0.153-0.815）,clot formation time K（OR = 0.089;95% CI: 0.014-0.557）,clot formation rate α（OR= 1.142;95% CI: 1.016-1.283）,maximum amplitude MA（OR= 1.133;95% CI:1.014-1.226）and coagulation index CI（OR = 2.082;95% CI: 1.242-3.491）were independent risk factors for postoperative VTE（P < 0.05）.（4）The results of the receiver operating curve showed that the age of 56.5years old was the critical value for predicting venous thromboembolism,the diagnostic sensitivity was 0.772（95%CI: 0.680-0.864）,and FEV1 2.17 L was the critical value for predicting venous thromboembolism,and the diagnostic sensitivity was 0.727（95%CI: 0.619-0.836）.The K value 1.55 min of postoperative thrombelastography parameters is the critical value for predicting venous thromboembolism,the diagnostic sensitivity is 0.751（95%CI: 0.650-0.853）,and the α angle 66.15 deg is the critical value for predicting venous thromboembolism,and the diagnostic sensitivity is 0.708（95%CI: 0.595-0.820）.CI 1.85 is the critical value for predicting venous thromboembolism,and the diagnostic sensitivity is 0.736（95%CI: 0.631-0.840）.When the age of patients with lung cancer is more than 56.5 years old,FEV1 is less than 2.17 L,postoperative K value is less than 1.55 min,postoperative α angle is greater than66.15 deg,postoperative CI is greater than 1.85,it is suggested that venous thromboembolism may occur after operation.Conclusion:（1）The incidence of VTE in postoperative patients with lung cancer is high,so we should pay attention to timely monitoring the status of venous thrombosis in postoperative patients with lung cancer.（2）Age,Postoperative TEG parameters R,K,α angle,MA and CI are independent risk factors for postoperative VTE.（3）Age,FEV1,K,α angle and CI have predictive value for postoperative venous thromboembolism.