Strategies for prevention and treatment of acute pulmonary embolism in patients with ground-glass nodules resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Yuping , XIE Dong , YANG Jian , CHEN Chang ,  JIANG Gening

Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, P.R.China;

Corresponding author：

JIANG Gening, Email: jgnwp@aliyun.com

Keywords：

Ground-glass nodule; pulmonary embolism; risk factor; risk assessment model

DOI：

10.7507/1007-4848.201804001

Video：

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Acute pulmonary embolism (PE) is a common disorder with significant morbidity and mortality in patients who underwent pulmonary ground-glass nodules (GGN) resection. We should make efforts to increase surgeons' awareness of risk factors of PE and their understanding of the effectiveness of prevention strategies. Using the optimal risk assessment model to identify high-risk patients and give them the individualized prophylaxis. Early diagnosis and accurate risk stratification is mandatory to reduce the rates of PE, to decrease health care costs and shorten the length of stay. This article summarizes the risk factors, diagnostic process, risk assessment models, prophylaxis and therapy for the PE patients who underwent GGN resection.

Citation： LI Yuping, XIE Dong, YANG Jian, CHEN Chang, JIANG Gening. Strategies for prevention and treatment of acute pulmonary embolism in patients with ground-glass nodules resection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(4): 465-470. doi: 10.7507/1007-4848.201804001 Copy

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13.	王永清, 鲍亚玲, 韩德兰, 等. 肌钙蛋白Ⅰ联合心功能参数在肺栓塞患者危险分层和短期预后评估中的价值. 中国老年学杂志, 2017, 37(23): 5924-5926.
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17.	Casazza F, Pacchetti I, Rulli E, et al. Prognostic significance of electrocardiogram at presentation in patients with pulmonary embolism of different severity. Thromb Res, 2018, 163: 123-127.
18.	Lee DS, Vo HA, Franco A, et al. Palla and westermark signs. J Thorac Imaging, 2017, 32(4): W7.
19.	Elliott CG, Lovelace TD, Brown LM, et al. Diagnosis: imaging techniques. Clin Chest Med, 2010, 31(4): 641-657.
20.	Kline JA. Diagnosis and exclusion of pulmonary embolism. Thromb Res, 2018, 163: 207-220.
21.	Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr Opin Pulm Med, 2010, 16(5): 448-452.
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23.	Hachey KJ, Hewes PD, Porter LP, et al. Caprini venous thromboembolism risk assessment permits selection for postdischarge prophylactic anticoagulation in patients with resectable lung cancer. J Thorac Cardiovasc Surg, 2016, 151(1): 37-44.
24.	Hachey KJ, Sterbling H, Choi DS, et al. Prevention of postoperative venous thromboembolism in thoracic surgical patients: implementation and evaluation of a caprini risk assessment protocol. J Am Coll Surg, 2016, 222(6): 1019-1027.
25.	Stashenko G, Lopes RD, Garcia D, et al. Prophylaxis for venous thromboembolism: guidelines translated for the clinician. J Thromb Thrombolysis, 2011, 31(1): 122-132.
26.	Wang C, Zhai Z, Yang Y, et al. Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism: a randomized, multicenter, controlled trial. Chest, 2010, 137(2): 254-262.
27.	Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: Chest guideline and expert panel report. Chest, 2016, 149(2): 315-352.
28.	Shen L, Li Y, Hernandez-Arenas LA, et al. Successful treatment of a pulmonary embolism with low dose of tissue plasminogen activator after thoracic surgery. Am J Emerg Med, 2016, 34(11): 2255-2259.
29.	Kucher N, Boekstegers P, Muller OJ, et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation, 2014, 129(4): 479-486.
30.	Kuo WT, Banerjee A, Kim PS, et al. Pulmonary embolism response to fragmentation, embolectomy, and catheter thrombolysis (PERFECT): initial results from a prospective multicenter registry. Chest, 2015, 148(3): 667-673.
31.	Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med, 2009, 361(24): 2342-2352.
32.	Buller HR, Prins MH, Lensin AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366(14): 1287-1297.
33.	Agnelli G, Buller HR, Cohen A, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med, 2013, 369(9): 799-808.
34.	Mismetti P, Laporte S, Pellerin O, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA, 2015, 313(16): 1627-1635.
35.	Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2012, 141(2 Suppl): e419S-e496S.
36.	Khorana AA, Carrier M, Garcia DA, et al. Guidance for the prevention and treatment of cancer-associated venous thromboembolism. J Thromb Thrombolysis, 2016, 41(1): 81-91.

1. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol, 2008, 28(3): 370-372.
2. Cohen AT, Agnelli G, Anderson FA, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost, 2007, 98(4): 756-764.
3. Christensen TD, Vad H, Pedersen S, et al. Venous thromboembolism in patients undergoing operations for lung cancer: a systematic review. Ann Thorac Surg, 2014, 97(2): 394-400.
4. 李镭, 刘丹, 朱盈盈, 等. 肺磨玻璃结节临床研究进展. 中国肺癌杂志, 2016, 19(2): 102-107.
5. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(43): 3033-3069, 3069a.
6. 钟继平. 开胸手术患者术后发生肺栓塞的危险因素研究. 当代医学, 2017, 23(27): 137-139.
7. 陆文西, 李永标. 开胸术后发生肺栓塞的危险因素分析. 中国医学创新, 2017, 14(13): 105-108.
8. Li YP, Shen L, Huang W, et al. Prevalence and risk factors of acute pulmonary embolism in patients with lung cancer surgery. Semin Thromb Hemost, 2018, 44(4): 334-340.
9. 王升玲, 孔英君. 年龄校正 D-二聚体在肺栓塞诊断的价值. 医学研究杂志, 2016, 45(8): 150-152.
10. Schouten HJ, Geersing GJ, Koek HL, et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ, 2013, 346: f2492.
11. 曹云, 张晓艳, 曹德勇, 等. D-二聚体年龄校正阈值与传统阈值在老年肺血栓栓塞症诊断中的应用价值比较. 国际检验医学杂志, 2017, 38(17): 2371-2373.
12. Hunt JM, Bull TM. Clinical review of pulmonary embolism: diagnosis, prognosis, and treatment. Med Clin North Am, 2011, 95(6): 1203-1222.
13. 王永清, 鲍亚玲, 韩德兰, 等. 肌钙蛋白Ⅰ联合心功能参数在肺栓塞患者危险分层和短期预后评估中的价值. 中国老年学杂志, 2017, 37(23): 5924-5926.
14. Kearon C. Diagnosis of suspected venous thromboembolism. Hematology Am Soc Hematol Educ Program, 2016, 2016(1): 397-403.
15. 焦亚彬, 耿园园, 李培秀, 等. 双源 CT 肺动脉造影及肺灌注成像对肺栓塞治疗后效果评价. 临床肺科杂志, 2018, 23(2): 288-291.
16. 张晓琴, 廖健, 王敏, 等. 实验性急性肺栓塞双源 CT 双能量肺灌注成像与 CTPA 的对照研究. CT 理论与应用研究, 2017, 26(2): 147-155.
17. Casazza F, Pacchetti I, Rulli E, et al. Prognostic significance of electrocardiogram at presentation in patients with pulmonary embolism of different severity. Thromb Res, 2018, 163: 123-127.
18. Lee DS, Vo HA, Franco A, et al. Palla and westermark signs. J Thorac Imaging, 2017, 32(4): W7.
19. Elliott CG, Lovelace TD, Brown LM, et al. Diagnosis: imaging techniques. Clin Chest Med, 2010, 31(4): 641-657.
20. Kline JA. Diagnosis and exclusion of pulmonary embolism. Thromb Res, 2018, 163: 207-220.
21. Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr Opin Pulm Med, 2010, 16(5): 448-452.
22. Caprini JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. Am J Surg, 2010, 199(1 Suppl): S3-S10.
23. Hachey KJ, Hewes PD, Porter LP, et al. Caprini venous thromboembolism risk assessment permits selection for postdischarge prophylactic anticoagulation in patients with resectable lung cancer. J Thorac Cardiovasc Surg, 2016, 151(1): 37-44.
24. Hachey KJ, Sterbling H, Choi DS, et al. Prevention of postoperative venous thromboembolism in thoracic surgical patients: implementation and evaluation of a caprini risk assessment protocol. J Am Coll Surg, 2016, 222(6): 1019-1027.
25. Stashenko G, Lopes RD, Garcia D, et al. Prophylaxis for venous thromboembolism: guidelines translated for the clinician. J Thromb Thrombolysis, 2011, 31(1): 122-132.
26. Wang C, Zhai Z, Yang Y, et al. Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism: a randomized, multicenter, controlled trial. Chest, 2010, 137(2): 254-262.
27. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: Chest guideline and expert panel report. Chest, 2016, 149(2): 315-352.
28. Shen L, Li Y, Hernandez-Arenas LA, et al. Successful treatment of a pulmonary embolism with low dose of tissue plasminogen activator after thoracic surgery. Am J Emerg Med, 2016, 34(11): 2255-2259.
29. Kucher N, Boekstegers P, Muller OJ, et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation, 2014, 129(4): 479-486.
30. Kuo WT, Banerjee A, Kim PS, et al. Pulmonary embolism response to fragmentation, embolectomy, and catheter thrombolysis (PERFECT): initial results from a prospective multicenter registry. Chest, 2015, 148(3): 667-673.
31. Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med, 2009, 361(24): 2342-2352.
32. Buller HR, Prins MH, Lensin AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366(14): 1287-1297.
33. Agnelli G, Buller HR, Cohen A, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med, 2013, 369(9): 799-808.
34. Mismetti P, Laporte S, Pellerin O, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA, 2015, 313(16): 1627-1635.
35. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2012, 141(2 Suppl): e419S-e496S.
36. Khorana AA, Carrier M, Garcia DA, et al. Guidance for the prevention and treatment of cancer-associated venous thromboembolism. J Thromb Thrombolysis, 2016, 41(1): 81-91.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Strategies for prevention and treatment of acute pulmonary embolism in patients with ground-glass nodules resection

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