Interpretation of expert ideas in the Sixth World Symposium of Pulmonary Hypertension（Ⅰ）——interpretation of the work report summary of expert group / 中国实用内科杂志

Since 1973 the World Symposia on Pulmonary Hypertension(WSPH)proceedings have summarised the scientific advances and future needs in this field through the efforts of multiple task forces, each focusing on a different aspect of pulmonary hypertension(PH). The task forces presented their consensus opinion after the 6 th WSPH held in Nice in 2018.This is an interpretation for the overview of the 6 th WSPH,which includes the following four aspects, translational medicine and precision medicine of PH, clinical research on PH, relevant research on several common types of PH, patient management and patient association.Among them, the most significant change is the new definition of hemodynamic standard of PH, but the implementation and use of the new standard, as well as the diagnosis and treatment of patients between the two standards still need further research and exploration. In addition, the importance of patient participation and management in the diagnosis and treatment and effective care of PH was clearly proposed for the first time.

Clinical Study of Acute Vasoreactivity Testing in Patients with Chronic Thromboembolic Pulmonary Hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The clinical significance of acute vasoreactivity testing (AVT) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) remains unclear. We analyzed changes in hemodynamics and oxygenation dynamics indices after AVT in patients with CTEPH using patients with pulmonary arterial hypertension (PAH) as controls.</p><p><b>METHODS</b>We analyzed retrospectively the results of AVT in 80 patients with PAH and 175 patients with CTEPH registered in the research database of Beijing Chao-Yang Hospital between October 2005 and August 2014. Demographic variables, cardiopulmonary indicators, and laboratory findings were compared in these two subgroups. A long-term follow-up was conducted in patients with CTEPH. Between-group comparisons were performed using the independent-sample t-test or the rank sum test, within-group comparisons were conducted using the paired t-test or the Wilcoxon signed-rank test, and count data were analyzed using the Chi-squared test. Survival was estimated using the Kaplan-Meier method and log-rank test.</p><p><b>RESULTS</b>The rates of positive response to AVT were similar in the CTEPH (25/175, 14.3%) and PAH (9/80, 11.3%) groups (P > 0.05). Factors significantly associated a positive response to AVT in the CTEPH group were level of N-terminal pro-brain natriuretic peptide (≤1131.000 ng/L), mean pulmonary arterial pressure (mPAP, ≤44.500 mmHg), pulmonary vascular resistance (PVR, ≤846.500 dyn·s-1·m-5), cardiac output (CO, ≥3.475 L/min), and mixed venous oxygen partial pressure (PvO2, ≥35.150 mmHg). Inhalation of iloprost resulted in similar changes in mean blood pressure, mPAP, PVR, systemic vascular resistance, CO, arterial oxygen saturation (SaO2), mixed venous oxygen saturation, partial pressure of oxygen in arterial blood (PaO2), PvO2, and intrapulmonary shunt (Qs/Qt) in the PAH and CTEPH groups (all P > 0.05). The survival time in patients with CTEPH with a negative response to AVT was somewhat shorter than that in AVT-responders although the difference was not statistically significant (χ2 =3.613, P = 0.057). The survival time of patients with CTEPH who received calcium channel blockers (CCBs) was longer than that in the group with only basic treatment and not shorter than that of patients who receiving targeted drugs or underwent pulmonary endarterectomy (PEA) although there was no significant difference between the four different treatment regimens (χ2 =3.069, P = 0.381).</p><p><b>CONCLUSIONS</b>The rates of positive response to AVT were similar in the CTEPH and PAH groups, and iloprost inhalation induced similar changes in hemodynamics and oxygenation dynamics indices. A positive response to AVT in the CTEPH group was significantly correlated with milder disease and better survival. Patients with CTEPH who cannot undergo PEA or receive targeted therapy but have a positive response to AVT might benefit from CCB treatment.</p>

Incidence and clinical characteristics of pulmonary hypertension in patients with idiopathic pulmonary fibrosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pulmonary hypertension (PH) frequently complicates the course of idiopathic pulmonary fibrosis (IPF) patients and is associated with significantly worse outcomes. The aim of the present study was to investigate the incidence of PH in IPF patients and evaluate the correlation between clinical parameters and systolic pulmonary artery pressure (sPAP).</p><p><b>METHODS</b>Hospitalized patients with IPF, who were evaluated for sPAP by Doppler echocardiography from January 2004 to December 2011, were enrolled in our study. Patients were defined as PH by an estimated sPAP > 50 mmHg and graded as PH likely, PH possible and PH unlikely, based on the 2009 European Society of Cardiology/European Respiratory Society PH Guidelines. The correlations between clinical parameters and sPAP were analyzed by multiple linear regression.</p><p><b>RESULTS</b>Totally, 119 IPF patients were enrolled in our study and 28 (23.5%), 20 (16.8%) and 71 (59.7%) patients were PH likely, PH possible and PH unlikely, respectively. Borg dyspnea score was positively correlated with sPAP, r = 0.467, P < 0.001. Oxygen saturation was negatively correlated with sPAP, r = -0.416, P < 0.001. Diffusing capacity of the lung for carbon monoxide percentage predicted was negatively correlated with sPAP, r = -0.424, P = 0.003. N-terminal fragment of pro-brain natriuretic peptide and pulmonary artery width was positively correlated with sPAP, r = 0.452, P = 0.011 and r = 0.513, P < 0.001, respectively.</p><p><b>CONCLUSIONS</b>The incidence of PH in IPF patients was 23.5% in a single center of China. PH may worsen the dyspnea, right heart dysfunction and decrease the life quality of the patients with IPF.</p>

Incidence of pleural effusion in patients with pulmonary embolism / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>No data on the incidence of pleural effusion (PE) in Chinese patients with pulmonary embolism are available to date. The aim of the current study was to investigate the frequency of PE in a Chinese population of patients with pulmonary embolism.</p><p><b>METHODS</b>This was a retrospective observational single-center study. All data of computed tomography pulmonary angiography (CTPA) performed over 6-year period on adult patients with clinically suspected pulmonary embolism were analyzed.</p><p><b>RESULTS</b>From January 2008 until December 2013, PE was identified in 423 of 3141 patients (13.5%) with clinically suspected pulmonary embolism who underwent CTPA. The incidence of PE in patients with pulmonary embolism (19.9%) was significantly higher than in those without embolism (9.4%) (P < 0.001). Majority of PEs in pulmonary embolism patients were small to moderate and were unilateral. The locations of emboli and the numbers of arteries involved, CT pulmonary obstruction index, and parenchymal abnormalities at CT were not associated with the development of PE.</p><p><b>CONCLUSIONS</b>PEs are present in about one fifth of a Chinese population of patients with pulmonary embolism, which are usually small, unilateral, and unsuitable for diagnostic thoracentesis.</p>

Serum Bilirubin and 6-min Walk Distance as Prognostic Predictors for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Prospective Cohort Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is a severe clinical syndrome characterized by right cardiac failure and possibly subsequent liver dysfunction. However, whether serum markers of liver dysfunction can predict prognosis in inoperable CTEPH patients has not been determined. Our study aimed to evaluate the potential role of liver function markers (such as serum levels of transaminase, bilirubin, and gamma-glutamyl transpeptidase [GGT]) combined with 6-min walk test in the prediction of prognosis in patients with inoperable CTEPH.</p><p><b>METHODS</b>From June 2005 to May 2013, 77 consecutive patients with inoperable CTEPH without confounding co-morbidities were recruited for this prospective cohort study. Baseline clinical characteristics and 6-min walk distance (6MWD) results were collected. Serum biomarkers of liver function, including levels of aspartate aminotransferase, alanine aminotransferase, GGT, uric acid, and serum bilirubin, were also determined at enrollment. All-cause mortality was recorded during the follow-up period.</p><p><b>RESULTS</b>During the follow-up, 22 patients (29%) died. Cox regression analyses demonstrated that increased serum concentration of total bilirubin (hazard ratio [HR] = 7.755, P < 0.001), elevated N-terminal of the prohormone brain natriuretic peptide (HR = 1.001, P = 0.001), decreased 6MWD (HR = 0.990, P < 0.001), increased central venous pressure (HR = 1.074, P = 0.040), and higher pulmonary vascular resistance (HR = 1.001, P = 0.018) were associated with an increased risk of mortality. Serum concentrations of total bilirubin (HR = 4.755, P = 0.007) and 6MWD (HR = 0.994, P = 0.017) were independent prognostic predictors for CTEPH patients. Patients with hyperbilirubinemia (≥23.7 μmol/L) had markedly worse survival than those with normobilirubinemia.</p><p><b>CONCLUSION</b>Elevated serum bilirubin and decreased 6MWD are potential predictors for poor prognosis in inoperable CTEPH.</p>

Association between KLKB1 Polymorphisms and Pulmonary Thromboembolism / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the potential correlation between the single nucleotide polymorphisms (SNPs) in the KLKB1 region and pulmonary thromboembolism(PTE) in a Chinese Han population.</p><p><b>METHODS</b>In this case-control study, 95 patients with confirmed PTE were enrolled as the PTE group and 90 healthy subjects as the control group. The genotypes, alleles, and haplotypes of the SNPs were analyzed with PLINK 1.07 and Haploview 4.2 software using chi-square test and Logistic regression analysis. SNPs were further analyzed under three genetic models (additive, dominant, and recessive).</p><p><b>RESULTS</b>The distribution of rs3733402 in KLKB1 gene showed significant difference between PTE group and control group (P=0.041). The distributions of GTG haplotypes consisted of rs2292423, rs4253325,and rs3733402 in KLKB1 gene were also significantly different between PTE group and control group(P=0.040).</p><p><b>CONCLUSION</b>The rs3733402 locus variation in KLKB1 gene is associated with PTE in Chinese Han people.</p>

Clinical features and imaging findings in pulmonary capillary hemangiomatosis: report of two cases and a pooled analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pulmonary capillary hemangiomatosis (PCH) is a rare disease and no Chinese case has been reported yet. The disease is often misdiagnosed and its clinical characteristics are incompletely described. The aim of this study was to describe two Chinese cases and to clarify the clinical and radiographic parameters of patients with PCH.</p><p><b>METHODS</b>Two PCH cases were presented and other cases were searched from the English literature. All available clinical and radiographic data were collected from 62 literature reported PCH cases. A pooled analysis of total 64 cases was made.</p><p><b>RESULTS</b>Dyspnea and hemoptysis were the most common clinical symptoms of PCH. Pulmonary hypertension (PH) was found in 78% of the reported cases. PCH typically showed characteristic diffuse or patchy ground-glass opacities (GGOs) and/or multiple ill-defined centrilobular nodules in the computed tomography.</p><p><b>CONCLUSIONS</b>The diagnosis of PCH requires a high clinical suspicion. However, both clinical presentations and radiographic studies often provide clues to the diagnosis, which may prompt early lung biopsy for a definite diagnosis.</p>

Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: preliminary exploration in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pulmonary endarterectomy is safe and effective surgical treatment for chronic thromboembolic pulmonary hypertension. This study aimed to evaluate the efficacy of pulmonary endarterectomy in treatment of thromboembolic pulmonary hypertension.</p><p><b>METHODS</b>A retrospective study of 15 patients who underwent pulmonary endarterectomy in Beijing Chaoyang Hospital was performed. Obvious pulmonary hypertension and hypoxemia were observed in all patients. Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest.</p><p><b>RESULTS</b>Two patients (2/15) died of residual postoperative pulmonary hypertension and bleeding complication. The other 13 cases had significant decrease in systolic pulmonary artery pressure ((92.8 +/- 27.4) mmHg vs. (49.3 +/- 18.6) mmHg) and pulmonary vascular resistance ((938.7 +/- 464.1) dynesxsxcm(-5) vs. (316.8 +/- 153.3) dynesxsxcm(-5)), great improvement in cardiac index ((2.31 +/- 0.69) Lxmin(-1)xm(-2) vs. (3.85 +/- 1.21) Lxmin(-1)xm(-2)), arterial oxygen saturation (0.67 +/- 0.11 vs. 0.96 +/- 0.22) and mixed venous O(2) saturation (0.52 +/- 0.12 vs. 0.74 +/- 0.16) postoperatively compared to preoperative data. Mid-term follow-up showed that the cardiac function of all cases returned to NYHA class I or II, with great improvement in 6-minute walking distance ((138 +/- 36) m) and quality of life.</p><p><b>CONCLUSIONS</b>Bilateral pulmonary endarterectomy using cardiopulmonary bypass with the aid of deep hypothermia and circulatory arrest can effectively reduce pulmonary hypertension and provide good mid-term hemodynamic and symptomatic results with low surgical mortality rate and few complications.</p>

Prognostic value of right ventricular dysfunction and derivation of a prognostic model for patients with acute pulmonary thromboembolism / 中华流行病学杂志

Objective Acute pulmonary thromboembolism(PTE)patients with right ventricular dysfunction(RVD)may benefit from thrombolytic therapy but may end up with worse prognosis.RVD was assessed in prognosis to which a model on it was constructed to decide the indexes correlated to the best prognosis.Methods This prospective study included 520 consecutive acute PTE patients from 41 hospitals in China between June 2002 and February 2005.All the patients were evaluated by transthoracic echocardiography(TTE),CT pulmonary angiography(CTPA),laboratory tests,and blood gas analysis.Physicians were asked to record all the clinical manifestations.Data from Univariate analysis demonstrated the parameters correlated with an 14-day clinically adverse outcomes.Multiple logistic regression analysis was used to decide the independent predictors and to construct a prognostic model.Results Mcan age of the patients was 57.4±14.1 years and 323 of them(62.1%)were male.The 14-day mortality in normotensive patients with RVD was higher(2.0%vs0.4%,P＜0.01)than those without.ROC curve showed the best cut.ofr values of RVED/LVED and SPAP for 14-day prognosis were 0.67 and 60 mm Hg,respectively.SPAP independently predicted 3-month clinicaI outcomes(P＜0.01).Results from Univariate analysis demonstrated tllat 24 parameters were correlated with an adverse 14-day clinical outcomes.which include palpation,syncope,panic,cyanosis,respiratory rate≥30/min,pulse≥110/min,jugular vein,accentuation of P2,murmurs in tricuspid area,time interval from onset,creatine phosphokinase(CPK),lactate dehydrogenase (LDH).alveolar-arterial PO2 difierence(PA-aO2),white blood cell(WBC)＜4.0×109/L or＞10.0×109/L,platelet.thrombus on TTE,RV/LV＞1.1,TRPG＞30 mm Hg,IVCmin＜8 mm,RVD,RVED/LVED＞0.6,SPAP＞60 mm Hg.RVWM.PTE range larger than two lobes or seven segments on CTPA.Furthermore,a multiple logistic regression model implied 8 predictors including RVD,RVED/LVED＞0.6,SPAP＞60 mm Hg,pulse≥110/min,accentuation of P2,Syncope,CPK,WBC＜4.0×109/L or＞10.0×109/L be independent predictors of an 14-day clinically adverse outcome(P＜0.01).This model seemed to fit well (P＜0.001).Wle chose a cut-off value as P≥0.2 and compared the model to the original derivation samples.Data showed that the sensitivity(true positive rate)was 81.82%,specificity was 92.11%.false positive rate was 18.18%.coincidence was 91.14%.and the concordarlCe rate was 80.96%.Conclusion RVD seemed a nice discriminator for poor prognosis in norrnotensive patients.Early detection of RVD(especially RVED/LVED＞0.67 and/or SPAP＞60 mm Hg)was beneficial for identifying patients at high-risk and the multiple logistic regression model(P＜0.001)could be well fitted.

Study on the risk factors regarding deep venous thrombosis in acute pulmonary thromboembolism / 中华流行病学杂志

<p><b>OBJECTIVE</b>To identify the risk factors of deep venous thrombosis(DVT) in patients with acute pulmonary thromboembolism (PTE).</p><p><b>METHODS</b>Post hoc analysis on data from a prospective multicenter through a randomized control trial on thrombolysis and anticoagulant among 454 patients with acute symptomatic PTE from June 2002 to December 2004. All patients were confirmed PTE by CT pulmonary angiography (CTPA) and/or ventilation perfusion scan or by magnetic resonance pulmonary angiography. Data of PTE patients with DVT was compared with those without DVT to identify the DVT risk factors. The effect of other variable on DVT was assessed by logistic regression analysis.</p><p><b>RESULTS</b>When comparing the age, sex body weight index and underlying diseases including hypertension, coronary heart disease, chronic obstructive pulmonary disease, cerebral accident and malignant tumor between groups of DVT and no DVT,data showed that there was no statistically significant difference except for diabetes (chi2 = 4.481, P = 0.034) among them.However,results from multi-analysis showed that edema of lower-limb [odd ratio (OR), 2.255; 95% CI, 1.493 to 3.408], phlebitis (OR, 2.380; 95% CI, 1.426 to 3.973) and the entire swollen (calf swelling > or =1 cm) larger than asymptomatic side (OR, 3.834; 95% CI, 2.561 to 5.738) were independent risk factors for DVT.</p><p><b>CONCLUSION</b>Edema of lower-limb, phlebitis and calf swelling > or =1 cm seemed to be risk factors for DVT.</p>

Prevalence and incidence of deep venous thrombosis among patients in medical intensive care unit / 中华流行病学杂志

Objective A cross-sectional study was carried out to observe the prevalence.Incidence and risk factors of deep venous thrombosis(DVT)in patients from intensive care unit(ICU).Methods Patients who were admitted to respiratory intensive care unit(RICU)and emergency intensive care unit (EICU)of Beijing Chaoyang Hospital and Bering Anzhen Hospital were screened in our studv.All patients enrolled underwent compression ultrasonography(CUS)witlain 48 h upon their admission to the ICUs.CUS Was re-performed at 10-14 day,or when 1eaving ICU or at the time patients developed signs and symptoms(pain,heat,redmess,edema)of DVT.Risk factors which were presumed assiated with DVT were recorded.The main identified outcome Was the presence of DVT.The secondary outcome Was pulmonary thromboembolism(FrrE).Results DVT was found in 30 patients of 252 patients within 48h (11.90％).One hundred seventy-two patients were perforrned CUS two times or more.26 patients(15.12％)had DVT.D-dimer,history of operation,kidney failure appeared to be independent risk factors for DVT in ICU patients.13 patients were suspected PTE and 3 patients diagnosed as PTE.Conclusion ICU doctors should pay more attention to DVT,which is relatively common in ICU patients.

Value of transthoracic echocardiography combined with cardiac troponin I in risk stratification in acute pulmonary thromboembolism / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute pulmonary thromboembolism (APE) causes right ventricular dysfunction (RVD) and cardiac troponin I (cTnI) elevation. Patients with RVD and cTnI elevation have a worse prognosis. Thus, early detection of RVD and cTnI elevation is beneficial for risk stratification. In this study, we assessed 14-day adverse clinical events and combined RVD on transthoracic echocardiography (TTE) with cTnI in risk stratification among a broad spectrum of APE patients.</p><p><b>METHODS</b>The prospective multi-centre trial included 90 patients with confirmed APE from 12 collaborating hospitals. Acute RVD on TTE was diagnosed in the presence of at least 2 of the following: right ventricular dilatation (without hypertrophy), loss of inspiratory collapse of inferior vena cava (IVC), right ventricular (RV) hypokinesis, tricuspid regurgitant jet velocity > 2.8 m/s. The study patients were divided into two groups according to clinical and echocardiographic findings at presentation: Group I: 50 patients with RVD; Group II: 40 patients without RVD.</p><p><b>RESULTS</b>More than half of the patients (50/90, 55.6%) had RVD. Nearly one third (26/90, 28.9%) of patients had elevated cTnI at presentation and only 4.2% on the fourth day after initial therapy. A multiple Logistic regression model implied RVD, right and left ventricular end-diastolic diameter ratio (RVED/LVED), and cTnI independently predict an adverse 14-day clinical outcome (P < 0.01). Receiver operating characteristics (ROC) curves revealed that the cut-off values of RVED/LVED and cTnI yielding the highest discriminating power were 0.65 and 0.11 ng/ml, respectively. Furthermore, the incidence of an adverse 14-day clinical event in patients with RVD and elevated cTnI was greater (40.7%) than in patients with elevated cTnI or positive RVD alone (0% and 8.3%, respectively) (P < 0.001).</p><p><b>CONCLUSIONS</b>RVD, RVED/LVED, and cTnI are independent predictors of 14-day clinical outcomes. The patients with RVED/LVED greater than 0.65 and cTnI higher than 0.11 ng/ml at presentation possibly have adverse 14-day events. RVD combined with cTnI can identify a subgroup of APE patients with a much more guarded prognosis.</p>

Study on the relationship between polymorphisms of susceptible genes in coagulation pathway related to pulmonary thromboembolism in Chinese Han population / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the prevalence of beta-fibrinogen gene -455G/A, -148C/T polymorphisms in Chinese Han population and to investigate whether they were associated with pulmonary thromboembolism (PTE).</p><p><b>METHODS</b>The subjects consisted of 101 patients with PTE and 101 healthy controls matched with age and sex, from the same geographic area. All patients were diagnosed by high probability of lung ventilation/perfusion scan and/or multi-slice CT pulmonary angiography as well as medical history and clinical manifestations. Genome DNA was extracted from whole blood using KI-phenol-chloroform. Genotypes and allele frequencies of fibrinogen beta gene -455G/A, -148C/T polymorphisms were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Restriction enzyme HaeIII and HindIII digestion were used for detecting -455G/A, -148C/T polymorphisms respectively.</p><p><b>RESULTS</b>Regarding fibrinogen beta gene -455G/A and -148C/, the allele frequencies G and A of fibrinogen beta -455 in the controls were 0.931, 0.069 while C and T of -148 were 0.777, 0.223 respectively, which were in good agreement with Hardy-Weinberg equilibrium. There was significant difference of -455G/A genotype frequencies distribution of AA, GA, GG between cases and in controls respectively, but no significant difference was found in the -148C/T polymorphisms. The frequencies of mutation allele -455A were 0.193, 0.169 in cases and in controls with P < 0.05 but there was no statistically significant difference of -148T allele. The presence of A allele of fibrinogen beta -455 was found to be a greater risk factor in cases than in controls. The odds ratio (OR) of GA and GA + AA were 3.723 (1.786 - 7.759), 3.749 (1.842 - 7.630), respectively. When compared with GG genotype, the P value was 0.0001.</p><p><b>CONCLUSION</b>There was a complete linkage disequilibrium between fibrinogen beta -148C/T and -455G/A found. The frequencies of -455A, alleles in PTE disease were apparently higher than that of healthy adults but there was no difference in -148T alleles.</p>

Comparison of unfractionated heparin and low molecular weight heparin in pulmonary thromboembolism: meta-analysis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To pool the data of studies about anticoagulation in non-massive pulmonary thromboembolism (PTE) and evaluate the efficacy and safety of low molecular weight heparin (LMWH) and unfractionated heparin (UFH) as the initial treatment.</p><p><b>METHODS</b>MEDLINE CD-ROM from January 1966 to August 2003 and CBM CD-ROM from January 1978 to August 2003 were chosen for searching the randomized clinical trials (RCTs) that compared the efficacy or safety of LMWH and UFH in non-massive PTE. A meta-analysis was employed to evaluate the results of these two therapies.</p><p><b>RESULTS</b>Five RCTs including 999 cases were analyzed. Compared with UFH, the combined odds ratio (OR) of LMWH in treating PTE was as follows: (1) The total OR of mortality of PTE patients treated with LMWH was 0.81 (95%CI 0.36-1.81, P > 0.05); (2) The total OR of recurrence of venous thromboembolism (VTE) in PTE patients treated with LMWH was 0.37 (95%CI 0.14-1.00, P=0.05); (3) The total OR of bleeding in LMWH was 0.47 (95%CI 0.16-1.39, P > 0.05);(4) The total OR of heparin-induced thrombocytopenia (HIT) in LMWH was 0.66 (95%CI 0.06-6.92, P > 0.05).</p><p><b>CONCLUSIONS</b>LMWH and UFH can reduce the mortality and recurrence of VTE in patients with PTE in the same degree. The risk of major bleeding was similar in the two treatment groups. Initial subcutaneous therapy with the LMWH appeared to be as effective and safe as intravenous UFH in the initial treatment of PTE.</p>