ABSTRACT
Objective:To investigate clinical features and risk factors for pulmonary embolism in elderly patients with tumor-associated venous thromboembolism(VTE).Methods:Patients aged ≥65 years with malignant tumors combined with deep venous thromboembolism(DVT)in our hospital from June 2014 to November 2018 were enrolled retrospectively.General information such as age, sex, date of hospitalization, primary tumor location, tumor metastasis, concomitant disease, thrombosis type and site were collected.The Charlson comorbidity index was calculated.According to the site of deep vein thrombosis, patients were divided into the DVT group and the pulmonary embolism(PTE)group.Risk factors for PE were analyzed statistically on the indicators in the two groups.Results:Of the 318 patients, 281(88.4%)were in the DVT group and 37(11.6%)were in the PE group.There were no statistically significant differences in age, sex, smoking history, length of hospital stay, primary tumor type or tumor metastasis between the two groups( P>0.05). The main comorbidities included hypertension, diabetes mellitus, atherosclerotic coronary disease, chronic obstructive pulmonary disease, heart failure, cerebrovascular disease, chronic kidney disease and chronic liver disease, and there was no statistically significant difference in the number of patients with the above diseases between the two groups( P>0.05). Charlson comorbidity index scores were higher in the PE group than in the DVT group(7.22±3.95 vs.5.69±2.89, P=0.028). Logistic regression analysis showed that age( OR=0.9, 95% CI: 0.846-0.985, P=0.001), tumor metastasis( OR=0.006, 95% CI: 0.001-0.032, P=0.000), and Charlson comorbidity index score( OR=2.278, 95% CI: 1.772-2.929, P=0.000)were all independent risk factors for PTE. Conclusions:Age, tumor metastasis and Charlson comorbidity index score are independent risk factors for PE in elderly tumor patients.
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Objective:To investigate the current status of anticoagulant therapy and the incidence of ischemic and bleeding events in hospitalized patients aged 90 years and over with non-valvular atrial fibrillation(NVAF).Methods:We retrospectively collected clinical data, antithrombotic treatment strategies, in-hospital ischemic stroke and bleeding events from NVAF patients(≥90 years)who were admitted to our hospital from June 2014 to August 2018.Based on the CHA 2DS 2-VASc score(2, 3, and ≥4 respectively), patients were divided into three ischemic risk groups, and antithrombotic treatment strategies and in-hospital ischemic stroke events were compared between the three groups.Alternatively, patients were divided into the high bleeding risk group(HAS-BLED score ≥3, )and the non-high bleeding risk group(HAS-BLED score ≤2), and antithrombic treatment strategies and the major bleeding events were compared between the two groups. Results:Among the 223 hospitalized NVAF patients aged 90 years and over, 42.6% of them received anticoagulant treatment, 25.6% received antiplatelet drugs, and 31.8% received non-antithrombotic treatment.With the increase of the CHA 2DS 2-VASc score, there was a trend of declined rates of non-antithrombotic treatment among the three ischemic risk groups(47.4%, 42.9%, 26.4%, P=0.06), and the rates of in-hospital ischemic stroke were similar among groups(10.5%, 12.2%, 15.5%, P=0.75). Moreover, compared with the non-high bleeding risk group, patients in the high bleeding risk group more frequently received anticoagulant treatment(47.2% vs.38.3%)and less frequently received non-antithrombotic therapy(28.7% vs.34.7%). There was no significant difference in antithrombotic treatment strategies( P=0.39)or rate of in-hospital major bleeding events(13.0% vs.10.2%, P=0.51). However, the rate of in-hospital major bleeding events was significantly higher in those with concurrent infections(16.8% vs.6.4%, P=0.02)or respiratory failure(21.3% vs.8.0%, P=0.01). Conclusions:The rate of anticoagulant use in NVAF patients aged 90 years and over is too low during hospitalization, and anticoagulant therapy should be standardized.In addition to the HAS-BLED score, we should consider the complications that increase the bleeding risk, such as infections and respiratory failure, when evaluating the bleeding risk.
ABSTRACT
BACKGROUND: Some researches show that aerobic kinesitherapy can strengthen the vagal tone that determines heart rate stability, increase the heart rate variability, and reduce the occurrence of cardiovascular events. OBJECTIVE: To observe the effect of aerobic kinesitherapy on vagal tone maintenance and the relevant indices of heart rate variability in elderly bedridden patients. DESIGN: A randomized controlled observation. SETTING: The Cadre Ward of Beijing Aerospace Central Hospital and Department of Comprehensive Internal Medicine,Yantai Convalescent Hospital of PLA. PARTICIPANTS: Totally 45 bedridden elderly male patients were selected from the patients admitted in the Cadre Ward of Beijing Aerospace Central Hospital and Department of Comprehensive Internal Medicine,Yantai Convalescent Hospital of PLA from February 2002 to January 2004.The patients were randomly divided into in treatment group (n =23, mean age of 69.5±8.0 years) and control group (n =22, mean age of 71.4±6.5). INTERVENTIONS:The therapeutic methods were similar in the two groups, I.e. Medications for amelioration of the circulation and neurotrophic treatment. On the basis of these treatments, the patients in the treatment group also had aerobic kinesitherapy through limb and trunk exercises with assistance to improve oxygen consumption of the body and increase the heart rate. In each session of exercise, the patients were supposed to attain the target heart rate of 70％ to 85％ of the personal highest safe heart rate.At the beginning, each session of exercise lasted for 10-15 minutes and the heart rate or pulse was measured every 4-6 minutes, with the patients'heart rate allowed to increase by no more than 20/minute and the patients not feeling tired. The subsequent exercise time gradually increased but not over 30-40 minutes, twice a day for no less than 5 days a week. Before and after the 20-week treatment, 24-hour dynamic electrocardiogram was examined to analyze the changes in the indices of heart rate variability. MAIN OUTCOME MEASURES: Before and after the 20-week treatment,the indices for heart rate variability were analyzed. The standard deviation of successive normal-to-normal R-R interval was determined for assessing the magnitude of vagus nerve activity, total power spectrum for the degree of heart rate variability, standard deviation of the mean value for the balance between the sympathetic nerve and vagus, low frequency for the dual regulation of the sympathetic nerves, root-mean-square derivations for short-term vagal function and heart rate changes, Edinburgh index for the sudden heart rate variationand the vagal activativity, high frequency for vagal regulation,and ratio of low frequency and high frequency for sympathetic nerve activity. RESULTS: This study involved initially 46 patients, 45 of whom completed the study and 1 patient died. After the 20-week treatment in treatment group, standard deviation of successive normal-to-normal R-R interval,standard deviation of the mean value, root mean square, Edinburgh index,high frequency and total power spectrum of heart rate variability were increased compared with those before treatment (t =12.5-38.4, P ＜ 0.01).The indices of heart rate variability was decreased in the control group 20weeks later (P ＜ 0.01). CONCLUSION: Aerobic kinesitherapy can improve the vagus nerve activity and the sympathetic-vagal balance, raise heart rate variability and reduce the occurrence of cardiovascular events.