Genetic Polymorphism of NOS3 with Susceptibility to Deep Vein Thrombosis after Orthopedic Surgery: A Case-Control Study in Chinese Han Population

Deep vein thrombosis is one of the common complications of orthopedic surgery. Studies indicated that genetic factors played a considerable role in the pathogenesis of deep vein thrombosis. Endothelial nitric oxide synthase which encoded by nitric oxide synthase 3 (NOS3), can generate nitric oxide in endothelial cells. As a predominant regulator for vascular homeostasis, nitric oxide might be involved in the pathogenesis of thrombosis. It had been proved that the NOS3 polymorphism (rs1799983) was associated with the development of cardiovascular diseases. Our objective was to evaluate the association between the NOS3 polymorphism (rs1799983) and deep vein thrombosis after orthopedic surgery in Chinese Han population. The polymorphism was genotyped in 224 subjects with deep vein thrombosis after orthopedic surgery and 580 controls. Allele and genotype frequencies were compared between subjects with deep vein thrombosis and control subjects. The allele and genotype frequencies of the NOS3 polymorphism (rs1799983) were significantly different between subjects with deep vein thrombosis and control subjects. There were also significant differences when the subjects were stratified by gender, surgery type and hypertension status. These findings suggested that the NOS3 polymorphism (rs1799983) was associated with susceptibility to the deep vein thrombosis after orthopedic surgery in Chinese Han population, and NOS3 might play a role in the development of deep vein thrombosis after orthopedic surgery.     

78例脑血栓患者清栓酶治疗前后体外血栓形成变化分析

本文对比了用清栓酶治疗前后脑血栓患者体外血栓形成各因素的变化,其中发现脑血栓患者治疗前体外血栓长度,湿干重量与健康人相比增长,加重[P<0.05或<0.01]。而清栓酶治疗后脑血栓患者体外血栓长度,湿干重量与治疗前相比明显降低(P<0.01)。从而证实了清栓酶具有降低血栓形成因子,抗血栓形成,改善微循环之功效。     

Diagnostic Accuracy in Venous Thrombosis

A group of 111 surgical patients at high risk of venous thrombosis were studied after operation by independent clinical assessment and with ¹²⁵I-fibrinogen to detect venous thrombosis. Almost half of the patients developed venous thrombosis. Of these, two-thirds were not suspected clinically despite careful scrutiny. In the patients in whom a clinical diagnosis of venous thrombosis was made this diagnosis was falsely positive in a quarter. More than half of all thrombotic episodes were detectable on the day after operation.The prevalence of venous thrombosis, together with the difficulty in diagnosing it, strongly supports the argument that a reduction in the incidence of pulmonary embolism must depend on widespread adoption of effective prophylaxis, especially in the large number of patients at high risk of venous thrombosis. Prophylactic trials must be objectively assessed, and it is in this field that the ¹²⁵I-fibrinogen technique probably has the most to offer.     

Influence of Smoking on Deep Vein Thrombosis after Myocardial Infarction

As part of a study of the factors affecting the risk of deep vein thrombosis after myocardial infarction a surprising and unexplained finding was that non-smokers had a significantly higher incidence of thrombosis than cigarette smokers.     

Heparin and phenprocoumon inhibit kappa-carrageenin induced thrombosis in rats

The tail thrombosis after kappa-carrageenin injection in rats was significantly inhibited by heparin and phenprocoumon. Heparin was yet effective at doses as low as 150 IU/kg. The present data point to an involvement of blood coagulation in this new model. Injection of cobra venom factor with complement depletion caused no thrombosis inhibition. The differences between the present kappa-carrageenin induced thrombosis model and a disseminated intravascular coagulation after lambda-carrageenin are discussed.     

Deep venous thrombosis and occult malignancy: an epidemiological study.

OBJECTIVE--To determine the risk of subsequent cancer in patients with deep venous thrombosis confirmed by venography. DESIGN--Follow up of all patients who had venography for suspected deep venous thrombosis during 1984-88. Patients were traced through a cancer registry up to 1 January 1991. SUBJECTS--4399 patients who had phlebography in one hospital. SETTING--General hospital in Malmö, Sweden, serving a population of 230,000. MAIN OUTCOME MEASURE--Number of cancers recorded. RESULTS--4399 patients had venography for suspected deep venous thrombosis; 604 were known to have a malignancy at the time of venography and were excluded from further analysis. 1383 had deep venous thrombosis, 150 of whom subsequently developed cancer. 182 of the 2412 patients without thrombosis developed cancer. During the first six months after venography 66 patients with thrombosis developed malignancy compared with 37 patients without thrombosis (P < 0.0001). 38 of the cancers in the deep venous thrombosis group were detected by history, physical examination, and laboratory tests. Three patients had postoperative or post-traumatic deep venous thromboses. Only two of the remaining patients would have benefited from early detection by extensive screening. After six months the incidence of cancer was identical in patients with and without thrombosis. CONCLUSION--Deep venous thrombosis is associated with a significantly higher frequency of malignancy during the first six months after diagnosis. Malignancies can be found with simple clinical and diagnostic methods and extensive screening is not required.     

After-exercise thermography and prediction of deep vein thrombosis.

A total of 112 patients participated in a prospective study of after-exercise thermography as a screening method for predicting risk of postoperative deep venous thrombosis. The fibrinogen-uptake test was used to detect thrombosis after elective surgery. The incidence of the complication showed no significant difference between patients who had had positive and those who had had negative thermograms. Thermography does not seem to be useful for predicting risk of postoperative thrombosis.     

血栓弹力图指导支架内血栓后不稳定心绞痛治疗1 例及文献复习

目的:探讨在血栓弹力图监测血小板抑制率的情况下,调整氯吡格雷及阿司匹林用量,治疗冠心病、PCI术后支架内再发血栓患者的临床意义。方法:报告中国人民解放军总医院1例支架内亚急性血栓患者的临床资料并复习相关文献,对其临床表现、诊断、在血栓弹力图指导下的治疗进行分析。结果:1例支架内亚急性血栓患者经治疗病情好转出院,出院后继续调整氯吡格雷及阿司匹林用量,达到满意血小板抑制率,患者症状消失。结论:冠状动脉介入治疗后发生支架内血栓的患者,应用血栓弹力图指导氯吡格雷及阿司匹林用量,可达到令人满意的血小板抑制率,并防止出血情况发生。     

128排CT对股骨头置换术后下肢深静脉血栓形成的诊断价值分析

摘要 目的：探讨与分析128排电子计算机断层扫描(Computed Tomography,CT)对股骨头置换术后下肢深静脉血栓形成的诊断价值。方法：2015年1月到2020年7月选择在本院诊治的股骨头置换术后疑似下肢静脉血栓形成患者78例作为研究对象,所有患者都给予128排CT检查,记录影像学特征并判断诊断价值,分析下肢深静脉血栓形成的影响因素。结果：在78例患者中,128排CT判断图像优69例,良9例,优良率为100.0 %。静脉造影判定为术后发生下肢深静脉血栓形成11例(DVT组),发生率为14.1 %,检出病变血管45支。二分类多因素Logistic回归分析显示术中出血量、手术时间、使用激素、年龄是导致股骨头置换术后下肢深静脉血栓形成的重要因素(P<0.05)。DVT组的血容量(cerebral blood volume,BV)与达峰时间(time to peak,TTP)值高于非DVT组(P<0.05),血流量(blood flow, BF)与平均通过时间(mean transit time,MTT)值低于非DVT组(P<0.05)。DVT组的血管狭窄评分低于非DVT组(P<0.05)。128排CT对股骨头置换术后下肢深静脉血栓形成的诊断敏感性与特异性为100.0 %和97.0 %。结论：术中出血量、手术时间、使用激素、年龄是导致股骨头置换术后下肢深静脉血栓形成的重要因素,128排CT能有效检出下肢深静脉血栓形成情况,具有方便、快捷、无创的特点,可为临床诊治提供可靠依据。     

Hypofibrinolysis and thrombophilia

The fibrinolytic capacity was assessed in 18 healthy subjects and in 8 patients each with non-idiopathic venous thrombosis, idiopathic venous thrombosis and myocardial infarction after intravenous administration of 1-deamino-8-D-arginine vasopressin (DDAVP) (0.4 microgram/kg) in comparison to venous occlusion. In healthy subjects the results obtained by either stimulus were approximately in agreement. Compared to the control group, in patients with non-idiopathic venous thrombosis the fibrinolytic capacity was not changed either after venous occlusion or after administration of DDAVP. In 5 out of 8 patients with idiopathic venous thrombosis the capacity was significantly reduced both after venous occlusion and after administration of DDAVP. In 4 out of 8 patients with myocardial infarction the capacity was significantly below the limit after administration of DDAVP while it was not after venous occlusion. In determining the fibrinolytic capacity DDAVP proved to be superior to venous occlusion.     

冠状动脉支架植入术后高凝状态的研究进展

支架内血栓形成是冠状动脉支架植入术后的重要并发症之一,尽管发生率较低,但严重者可危及生命。冠心病支架植入术后高凝状态源自患者的自身因素及支架植入所导致的一系列病理生理反应,包括斑块破裂、血管内皮损伤、组织因子大量表达、微粒生成增多等,进一步可激活血细胞和凝血系统,重者可导致局部血栓形成。及时检测及防治支架术后的高凝状态对降低支架内血栓的发生率有积极作用。本文主要对冠状动脉支架植入术后高凝状态的研究进展进行了综述。     

Involvement of bioantioxidants in thrombosis in mice

SUMMARY

An involvement of free radicals in thrombosis has been suggested previously. In order to further explore the role of free radicals and antioxidants in thrombosis, we have measured preventive (enzymes of the glutathione redox cycle) and chain-breaking antioxidants (vitamin E and C) in whole blood, platelets, neutrophils (PMNLs), heart and lung following collagen and adrenaline induced thrombosis in mice. A significant decrease in platelet glutathione (GSH) level (54%) and glutathione reductase activity was observed after thrombosis. In addition, GSH content in whole blood was also found to be reduced. In PMNLs, an increase in glutathione peroxidase activity and a four-fold elevation in vitamin C content was observed following thrombosis. However, levels of vitamin E and total thiol groups remained unchanged in both the cells and tissues. The results further suggest involvement of free radicals and PMNLs in thrombosis.     

Deep venous thrombosis and pulmonary embolus after face lift: a study of incidence and prophylaxis

Deep venous thrombosis and pulmonary embolus are known risks of surgery. However, the incidence of these conditions in face lift is unknown. In this study, the incidence of deep venous thrombosis/pulmonary embolus after face lift is studied and factors associated with thromboembolic complications are evaluated. One-third of the active members of the American Society for Aesthetic Plastic Surgery were randomly selected. Participating surgeons completed a one-page survey providing information on face-lift procedures during a 12-month study period. A response rate of 80 percent was achieved, with 273 of the 342 surgeons responding to the survey. A total of 9937 face-lift procedures were reported in the 1-year study period. There were 35 patients with deep venous thrombosis (0.35 percent), 14 patients with pulmonary embolus (0.14 percent), and 1 patient death in the series. Although 43.5 percent of patients underwent face lift under general anesthesia, 83.7 percent of deep venous thrombosis/pulmonary embolus events occurred with general anesthesia. For prophylaxis for deep venous thrombosis/pulmonary embolus, 19.7 percent of the surgeons used intermittent compression devices, 19.6 percent used thromboembolic disease hose or Ace wraps, and 60.7 percent used no prophylaxis. Of patients developing deep venous thrombosis/pulmonary embolus, 4.1 percent were treated prophylactically with intermittent compression devices, 36.7 percent with thromboembolic disease hose/Ace wraps, and 59.2 percent with no prophylaxis. It was found that deep venous thrombosis/pulmonary embolus after face lift is a measurable complication experienced by one of nine surgeons surveyed. Deep venous thrombosis/pulmonary embolus is more likely to occur when the procedure is performed under general anesthesia. The majority of plastic surgeons surveyed used no prophylaxis for deep venous thrombosis when performing face-lift procedures. Intermittent compression devices were associated with significantly fewer thromboembolic complications, whereas Ace wrap/thromboembolic disease hose afforded no protection against deep venous thrombosis/pulmonary embolus when used alone. In conclusion, aesthetic surgeons should consider adopting intermittent compression devices when performing face lift under general anesthesia.     

门静脉高压症脾切断流术后血栓形成的临床研究

目的:探讨门静脉高压症脾切断流术后门静脉系统血栓形成的相关原因。方法:回顾性分析2010年4月-2011年12月我科450例因肝硬化门静脉高压症行脾切断流术患者的临床资料,应用超声多普勒检测手术前后门静脉血流速度、门静脉直径及脾静脉、肠系膜上静脉、门静脉血栓情况,用Logistic回归分析术前肝功能Child-Pugh分级、门静脉直径、门静脉血流速度、脾脏的质量及术后血小板数量与门静脉系统血栓形成的关系。结果:术前门静脉系统有血栓患者75例,占16.7%。术后门静脉血栓再形成率52.9%。Logistic单因素分析提示门静脉系统血栓形成与门静脉内径、门静脉血流速度、脾脏质量、血清总胆红素、术后血小板数量有关。多因素分析发现门静脉系统血栓形成与门静脉内径、门静脉血流速度、脾脏质量有关,而与血清总胆红素、术后血小板数量无关。结论:肝硬化门静脉高压症脾切除术后门静脉系统血栓形成与门静脉内径、门静脉血流速度、脾脏质量有关。     

Incidence of early post-operative iliofemoral thrombosis.

The doppler ultrasound probe was used to study 138 patients after major surgery to assess the incidence of iliofemoral thrombosis in the early postoperative period. The patients were simultaneously studied with the 125-I-fibrinogen uptake test. The accuracy of the ultrasonic technique was assessed concurrently by comparing its results with those of ascending phlebography in a separate group of patients. The ultrasound probe detected thrombus proximal to the calf but was inaccurate in locating its exact site. Of the 138 patients studied postoperatively 28 developed calf vein thrombosis detected istopically, but there was no evidence of iliofemoral thrombosis in any patient. Thus, spontaneous iliofemoral thrombosis in the early postoperative period is rare.     

Long-Term Survival in a Large Cohort of Patients with Venous Thrombosis: Incidence and Predictors

Background

Venous thrombosis is a common disease with a high mortality rate shortly after the event. However, details on long-term mortality in these patients are lacking. The aim of this study was to determine long-term mortality in a large cohort of patients with venous thrombosis.

Methods and Findings

4,947 patients from the Multiple Environmental and Genetic Assessment study of risk factors for venous thrombosis (MEGA study) with a first nonfatal venous thrombosis or pulmonary embolism and 6,154 control individuals without venous thrombosis, aged 18 to 70 years, were followed up for 8 years. Death and causes of death were retrieved from the Dutch death registration. Standardized mortality ratios (SMRs) were calculated for patients compared with control individuals. Several subgroups were studied as well.736 participants (601 patients and 135 controls) died over a follow-up of 54,948 person-years. The overall mortality rate was 22.7 per 1,000 person-years (95% CI 21.0–24.6) for patients and 4.7 per 1,000 person-years (95% CI 4.0–5.6) for controls. Patients with venous thrombosis had a 4.0-fold (95% CI 3.7–4.3) increased risk of death compared with controls. The risk remained increased up to 8 years after the thrombotic event, even when no additional comorbidities were present. The highest risk of death was found for patients with additional malignancies (SMR 5.5, 95% CI 5.0–6.1). Main causes of death were diseases of the circulatory system, venous thrombosis, and malignancies. Main limitation was a maximum age of 70 at time of inclusion for the first event. Therefore results can not be generalized to those in the highest age categories.

Conclusions

Patients who experienced a first venous thrombosis had an increased risk of death which lasted up to 8 years after the event, even when no comorbidities were present at time of thrombosis. Future long-term clinical follow-up could be beneficial in these patients. Please see later in the article for the Editors'' Summary     

The effect of ozagrel sodium on photochemical thrombosis in rat: therapeutic window and combined therapy with heparin sodium

The therapeutic efficacy of ozagrel sodium (ozagrel), alone and in combination with heparin, and its therapeutic time window were studied in a photochemically induced thrombotic cerebral infarction rat model. Cerebral artery thrombosis was induced by irradiating the brain with green light through intact skull using rose bengal as the photosensitizing dye. One set of animals was treated immediately after thrombosis with (1) vehicle, (2) 10 mg/kg ozagrel in saline, intravenously (i.v.), (3) 150 U/kg unfractioned heparin, subcutaneously (s.c.), or (4) ozagrel, i.v. plus heparin, s.c. Infarct volume was significantly smaller and edema was reduced in the ozagrel-treated groups compared to the vehicle-treated group; heparin did not convey additional benefit. In another set of animals, rats were given either vehicle or 10 mg/kg ozagrel in saline, i.v., 60 min or 120 min after induction of thrombosis. Ozagrel reduced infarct volume, but its effect diminished with delayed administration. The therapeutic window was determined to be less than 60 minutes after induction of thrombosis.     

Effect of the action of anodal direct current on venous blood characteristics in vitro

Intravasal application of anodic direct current usually results in the development of a separate thrombosis. Thrombotic occlusion made successively by means of direct current will lead to an acceleration of the second thrombosis. Significant alterations of the examined parameters in the sense of an increased readiness to coagulation and acidosis could be proved after the impact of anodic direct current on the blood in vitro. The development of coagulation thrombosis and obstruction of microcirculation in the supply area are could be observed when the blood which in vitro had been exposed to the effect of the anodic direct current was transfused into the arterial blood circulation.     

骨科术后下肢深静脉血栓形成与超声弹性成像参数的相关性

摘要 目的：探讨骨科术后下肢深静脉血栓形成与超声弹性成像参数的相关性。方法：选取2021年6月~2022年6月在我院骨科进行诊治的术后下肢深静脉血栓患者80例为观察组,再选择同期术后健康者60例为对照组。比较两组超声弹性评分、应变值;采用Pearson检验分析超声弹性评分、应变值与肢深静脉血栓形成之间的相关性;采用多因素Logistic回归分析影响下肢深静脉血栓形成的独立危险因素;采用受试者工作特征曲线（ROC）分析超声弹性评分、应变值预测下肢深静脉血栓形成的价值。结果：观察组超声弹性评分、应变值均高于对照组（P＜0.05）。Pearson相关性检验显示,超声弹性评分、应变值与下肢深静脉血栓形成均呈正相关（r=0.785、0.826,P<0.05）。多因素Logistic回归分析结果显示,超声弹性评分、应变值是影响下肢深静脉血栓形成的独立危险因素（OR=4.632、4.768,P<0.05）。ROC曲线分析结果显示,超声弹性评分、应变值在预测下肢深静脉血栓形成中具有极高的价值。结论：随着下肢深静脉血栓的形成,患者超声弹性评分、应变值升高,该两项指标在预测下肢深静脉血栓形成中具有极高的价值,临床上可借助该两项指标的参数值对骨科术后下肢深静脉血栓形成进行预判。     

Late results of treatment of deep vein thrombosis

Twenty-two patients who had an acute episode of thrombosis in the deep veins of the legs were studied by a new technique of ascending functional cinephlebography 6 to 12 months after the episode of thrombosis.If the condition was diagnosed within 36 hours and the thrombus was dissolved rapidly valve function was preserved. When diagnosis was delayed there was a very great risk of permanent damage to the valves.