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Prevalence and risk factors of deep venous thrombosis of hospitalizations in plateau: a cross-section analysis

Journal of Cardiothoracic Surgery volume 19, Article number: 441 (2024) Cite this article

Abstract

Background

Deep venous thrombosis (DVT) is a serious public health issue that threatens human health and economic development. Presently, differences in the prevalence of DVT among individuals from different nationalities, residents of high-altitude areas, and those consuming any special diet are unknown. Therefore, we aimed to elucidate the prevalence of and the associated risk factors for DVT in hospitalized patients in the plateau areas.

Methods

The subjects were hospitalized patients in three grade III-a hospitals in the Qinghai Province, China, during January–October 2020. The demographic, clinical, and laboratory data were collected at admission, and ultrasonography of the bilateral lower extremities was performed. The hospital stay-duration was recorded at the time of discharge.

Results

A total of 3432 patients were enrolled, of which 159 (4.60%) were diagnosed with DVT. The age of > 50 years (OR = 2.434, 95% CI: 1.521–3.894252, P < 0.001), residence altitude of ≥ 3000 m (OR = 2.346, 95% CI: 1.239–4.440, P = 0.009), D-dimer level of ≥ 0.5 mg/L (OR = 2.211, 95% CI: 1.547–3.161, P < 0.001), presence of comorbidities (OR = 1.904, 95% CI: 1.386–2.705, P < 0.001), a history of varicose veins (OR = 1.990, 95% CI: 0.959–4.128, P = 0.045), and current medications (OR = 2.484, 95% CI: 1.778–3.471, P < 0.001) were identified as risk factors for DVT in these plateau areas.

Conclusion

The prevalence of DVT in the hospitalized patients of the studied plateau areas was 4.60%. We recommend considering individualized risk stratification (age > 50 years, residence altitude ≥ 3000 m, a history of varicose veins, D-dimer level ≥ 0.5 mg/L, current medications, and comorbidities) for patients at the time of admission.

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Background

Deep venous thrombosis (DVT) is a venous return disorder caused by abnormal blood clotting in deep veins, and it usually affects the lower extremities. Thrombus migration can cause pulmonary embolism (PE) [1, 2], which can significantly affect the quality of life and even lead to death [3, 4]. The incidence of DVT is 88–112/100 000 person-years [5], and the total incidence of DVT among adults is 50–100/100 000 persons [6]. The most serious complication of DVT is PE, which has been associated with 50,000–200,000 deaths every year [7]. As such, DVT has become a serious public health issue that threatens human health and economic development.

Approximately 500 million people worldwide live at high altitudes [8]. At such altitudes, the air is thin, oxygen partial pressure is low, and the body is in an obvious state of hypoxia. Therefore, the prevalence of DVT is significantly higher in these areas compared to that in plain areas [9, 10]. A past study reported that lowlanders living at high altitudes have a 30–44-times higher risk of presenting to hospitals with DVT than those living at low altitudes [11]; however, data on the prevalence of DVT in high-altitude hospitalized patients are inadequate.

The main causes of DVT are slow blood flow, vessel wall injury, and hypercoagulability. The established risk factors include a history of DVT, presence of a malignant transformation, increasing age, cigarette smoking, obesity, prolonged bed rest, trauma or fracture, surgery, pregnancy and puerperium, use of oral contraceptives and hormone therapy, and general anesthesia [4, 6]. Exposure to high altitudes and hypoxia are the recognized predisposing factors for venous thrombosis [2, 4, 12]. Furthermore, increased red blood cell and blood viscosity [8, 13], platelet aggregation and coagulation activation [4, 14], and vascular endothelial cell damage caused by hypoxia increase the risk of thrombosis in high-altitude hospitalized patients [2, 9, 13, 14]; these reports suggest the presence of other risk factors in plateau areas, warranting further research.

Qinghai province is located in the Qinghai–Tibet Plateau and has an average elevation of approximately 3500 m above sea level. It is a multiethnic region; in addition to the Han nationality, people from many other ethnic minorities such as Tibetan, Hui, Salar, Tu, and Mongolian also live here. These people’s diet is especially high in salt and fat. Presently, no studies have determined whether there are differences in the prevalence of DVT among different nationalities and residence altitudes and whether any special diet culture affects DVT formation. Therefore, it is important to understand the effect of ethnic characteristics, different altitudes, and special diet culture on DVT formation in plateau areas. The present study aimed to investigate the prevalence of DVT in hospitalized patients in plateau areas as well as analyze its risk factors to provide a basis for DVT prevention in plateau areas and also establish a risk assessment system for DVT in plateau areas.

Methods

Participants

In this cross-sectional study, we enrolled patients who were hospitalized between January 1, 2020, and December 31, 2020, in three third-class A hospitals in the Qinghai-Tibet Plateau using the following inclusion criteria: [1] patients residing in Qinghai for ≥ 10 years [2], those who were ≥ 18 years of age, and [3] those who voluntarily agreed to participate after providing written informed consent. The exclusion criteria were as follows: [1] patients with difficulty in language communication or understanding [2], those with disturbance of consciousness and who were unable to communicate effectively; further, their caregivers were unable to provide effective information, and [3] patients who were in emergency treatment and died within 24 h after admission. All patients in this study provided their written informed consent. The study was approved by the ethics committee of Qinghai Provincial People’s Hospital (2020-48). All procedures involving human participants were conducted according to the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Sample size

According to the empirical criteria, the sample size for logistic regression analysis should be 10–15 times the covariate numbers. Accordingly, this study considered 26 covariates; therefore, the sample size was 260–390. Considering 20% of sample shedding, the sample size was ensured to be not less than 468.

DVT diagnosis

Duplex ultrasonography (DUS) was performed to diagnose DVT. All participants underwent DUS of bilateral lower extremities at the time of admission, and all patients were collected at the same time-point for DUS. We use data from routine DUS. The diagnostic criteria for DVT were noncompressed veins, lumen obstruction or filling defect, lack of respiratory vibration above the knee vein segment, and inadequate flow augmentation to the calves [15]. DUS included the common femoral vein, superficial femoral and deep femoral, popliteal, anterior tibial, posterior tibial, and common fibular veins. Blood clots located in the intermuscular veins (i.e., the gastrocnemius and soleal veins) were not included.

Data collection

The data collected were demographic variables (age/sex/nationality/residence/body mass index), history of smoking or drinking alcohol, diet consumption (boiled tea/ghee/beef/ mutton), activity ability, diagnoses, comorbidities, family history of DVT, history of varicose veins, current medications, lower limb edema, laboratory examination results (red blood cell count/platelet count/prothrombin time/thrombin time/activated partial thromboplastin time/fibrinogen/D-dimer/fibrinogen degradation products [FDPs]), and total length of hospital stay.

Statistical analysis

Data analysis was performed using SPSS23.0 (IBM, Armonk, New York, United States). Demographics and measured variables were characterized using descriptive statistics (i.e., mean ± SD, quartile median, and proportions). Continuous variables were analyzed using the Student’s t-test for independent samples or the Mann–Whitney U-test for non-normal distribution variables. Categorical variables were analyzed using the chi-squared test. Multivariate logistic regression analysis was performed to identify the risk factors. The odds ratio (OR) and 95% confidence interval (CI) were used to express the strength of the correlations. P < 0.05 was considered to indicate statistical significance.

Results

Patient characteristics

In total, 3432 patients were enrolled in this study; of them, 159 (4.60%) patients were diagnosed with DVT. Table 1 lists the characteristics of the study participants.

Table 1 Patients characteristics (n = 3432)
Full size table

Differences in the characteristics of patients without and with DVT

Compared with patients without DVT, those with DVT had a longer total length of hospital stay (16.40 ± 7.66 vs. 14.77 ± 8.55, P < 0.05). Tables 2 and 3 present the comparison results of the characteristics of the patients without and with DVT. Significant differences were observed in 11 variables: D-dimer levels, FDPs, sex, age, residence altitude, alcohol drinking, activity ability, diagnosis, comorbidities, history of varicose veins, and current medications.

Table 2 Comparison between non-DVT and with-DVT in all collected variables
Full size table
Table 3 Comparison between non-DVT and with-DVT in all collected variables
Full size table

Multivariate analyses of risk factors associated with DVT in hospitalizations in the plateau areas

The 11 variables were entered into the multivariate analysis, and the variables assignment are listed in Table 4. age (>50 years), residence attitude (≥ 3000 m), D-dimer level (≥ 0.5 mg/L), comorbidities, history of varicose veins, and current medications acted as independent risk factors of the DVT in high altitude, and patients with-DVT influenced the total hospital stay duration (Table 4.

Table 4 Multivariate analyses of risk factors associated with DVT in hospitalizations in plateau areas
Full size table

Discussion

In our study, the prevalence of DVT in hospitalized patients residing in the plateau areas was 4.6%; this was much higher than the findings of Loffredo et al.(0.25%) [16], Sun et al.(1.65%) [17], and Law et al.(0.03%) [18]. In 2010, a 9-month prospective study in China revealed that the incidence of DVT in China was 0.9%. The 25 hospitals included in this study were all located in plain areas, which further affirms that the plateau environment plays an important role in DVT formation. Hypoxia can lead to vascular wall damage, dysfunction of vascular endothelial cells covering the surface, and increased D-dimer and activated protein c resistance; furthermore, the body exhibits a state of promoting coagulation. On the other hand, it induces the secretion of Weibel–Palade bodies in vascular endothelial cells [2], which store various thrombus formation-related components. The stimulation of hypoxia can lead to changes in blood composition, including increased red blood cell count and hemocytosis, which increases blood viscosity and decreases blood flow [8], as well as promotes hypercoagulability.

We observed that the prevalence of DVT in inpatients residing at altitudes of ≥ 3000 m was considerably higher than that of those residing in altitudes of ≤ 3000 m (7.95% vs. 4.48%). Tibetans, an ethnic group living in the Tibetan Plateau, mostly reside in altitudes of > 3000 m. In the present study, the prevalence of DVT in hospitalized Tibetan patients was higher than that of other ethnic groups (Tibetan, 5.58%; Han, 4.73%; Hui, 2.90%); this may be one of the reasons for the high incidence of DVT in patients residing at altitudes of ≥ 3000 m. Deng et al. [19] compared the blood components of 222 patients who had been hospitalized in plateau areas and found that the levels of Hb and Hct and RBC count in the blood of the patients increased with an increase in the altitude.

We also observed that the prevalence of DVT in patients > 50 years was significantly higher than that in patients < 50 years (5.37% vs. 2.30%); this is consistent with the findings of Nordstrom et al. [20]. The risk of blood clots is strongly associated with aging [20, 21]. Hb level, Hct level, and RBC count in the blood of permanent residents in high-altitude areas increased with age [22]; further, the D-dimer level increased with age [5]. All these factors may increase the risk of DVT in people > 50 years.

The diagnostic value of D-dimer for thrombus was confirmed in the Guidelines for Diagnosis and Treatment of Acute Pulmonary Embolism in 2019 issued by the European Society of Cardiology [23]; it was further verified in the present study. We found that when patients’ D-dimer level is ≥ 0.5 mg/L, attention should be paid to evaluate the presence of DVT symptoms. The D-dimer level increases with age, leading to a decrease in the specificity of DVT diagnosis in elderly patients [5]. Righini et al. [24] suggest adjusting the D-dimer threshold for patients > 50 years to improve the specificity of DVT diagnosis; this aspect has been verified in related studies [24, 25]. Medical staff should not only pay attention to the D-dimer index of patients but also apply the age-adjusted D-dimer strategy to improve the diagnostic specificity for patients > 50 years [25].

This study indicates that comorbidity is an independent risk factor for DVT in hospitalized patients. Some studies [26,27,28] have reported that complications increase the thrombosis risk. In this study, we included 33.16% of patients with complications, and the prevalence of DVT was as high as 7.21%. A meta-analysis by Tang et al. [29] revealed that the risk of DVT in patients with stroke and complications of diabetes, coronary heart disease, atrial fibrillation, and heart failure increased by 1.63, 2.31, 1.55, and 1.96 times, respectively. Wei B et al. [30] and Wang S et al. [31] reported that patients with spinal diseases and hypertension, diabetes, and heart disease exhibited an increased risk of postoperative DVT. In patients with renal insufficiency, the risk of thrombosis was reported to increase by 5.5 times [32]. A prospective registry of 5451 patients with DVT by Goldhaber SZ et al. [33] reported that 50% of these patients had hypertension. Therefore, the medical staff should take active and effective preventive measures to minimize the onset of complications. For patients with complications, effective preventive measures for DVT should be taken while strengthening observation and evaluating factors to reduce DVT risk.

The present results suggest that varicose vein history is an independent risk factor for DVT in hospitalized patients. Varicose veins are common in the lower extremities of patients and are among the manifestations of venous insufficiency of the lower extremities. Wołkowski K. et al. have reported that varicose veins of the lower extremities were assessed as a possible risk factor for DVT [34]. A total of 2.71% of patients had varicose veins in this study, and the prevalence of DVT was as high as 10.75%. The incidence of chronic mountain sickness among residents living at altitudes > 2500 m was reported to be 5–10% [35, 36], including varicose veins. Gao et al. [37] studied 218 individuals living at an altitude of 3300–5400 m in 2019, and the findings revealed that the incidence of varicose veins in areas of high altitude was as high as 11.47%. For patients with varicose veins, it is necessary to understand the extent of varicose veins.

Current medications were found to be an independent risk factor for DVT in hospitalized patients. In this study, the proportion of patients taking medications was 25.79%, and the prevalence of DVT was as high as 8.81%. Various drugs are clinically applied. Drugs that have been proven to be likely to cause thrombosis include sedation, dehydration, and vasopressin drugs. These drugs induce hemodynamic changes and vascular damage in patients, among which vasopressin reduces the vascular lumen and increases the risk of thrombosis.

Antibiotics are commonly used to prevent and control infection and are very commonly used in clinical settings. Timp et al. [38] revealed that, with the use of antibiotics, the risk of VTE was 4.5 times higher and that of DVT was 3.2 times higher than that without the use of antibiotics. A population-based case-control study by Schmidt et al. [39] revealed a nearly three-fold increase in the risk of DVT after community antibiotic treatment. The mechanism of cefoperazone/sulbactam-induced coagulation dysfunction may be related to the presence of the N-methylthiotetrazolium side chain in cefoperazone, which possesses a molecular structure similar to that of glutamate. It competitively binds glutamate carboxylase along with vitamin K1 in the liver microsomes. The resulting structure affects the synthesis of vitamin K-dependent coagulation factors II, VII, IX, and X, thereby leading to coagulation dysfunction in the body [40]. Moreover, cefoperazone cannot be efficiently metabolized in the body, and > 40% is discharged from the bile duct through the intestine. Cefoperazone inhibits normal intestinal flora and the intestinal synthesis of vitamin K, resulting in vitamin K-dependent prothrombin hypoemia. These effects result in coagulation dysfunction, which is characterized by prolonged INR, PT, and APTT, as well as a bleeding tendency [41]. Therefore, medical staff should improve antibiotic-related awareness regarding the risk of thrombosis. Furthermore, they should rationally use antibiotics based on the results of drug sensitivity tests and reduce the administration of unnecessary antibiotics to reduce the risk of thrombosis.

The total length of hospital stay of patients with DVT in this study was longer than that of patients without DVT (16.40 ± 7.66 days vs. 14.77 ± 8.55 days, respectively). With an extended hospital stay, the economic burden on the patients, hospitals, and society also increases and brings more risks. Therefore, the prevention and treatment of DVT are particularly important. Thus, we can combine the characteristics of the plateau areas to build a VTE prevention and management system in the plateau areas, improve patient prognoses, improve the quality of medical treatment, and guarantee the medical safety of inpatients to reduce the VTE-related disease and economic burden.

Strength and limitation

Presently, the data on the prevalence of DVT among the inpatients on the Tibetan Plateau in China is very limited. Through our study findings, we could provide a basis for the prevention and treatment of DVT in the Tibetan Plateau in the future. Nonetheless, there are some limitations to our study. First, the outpatients were not included in this study, which may have underestimated the prevalence of DVT in the plateau areas. Second, the sample size was relatively small considering the large population of people in plateau areas, especially of the Zang, Hui, Sala, and Meng nationalities. Third, we neither classified the proportion of DVT in the various districts (such as femoral and popliteal) nor considered superficial vein thrombosis in this study. Although data on RBC and other coagulation indicators were collected, no statistical differences were noted between the DVT and non-DVT groups. Therefore, in the future, the levels of hemoglobin (Hb) and hematocrit (Hct) should also be considered. Fourth, the ethnic population of Tibet might possess an inborn hypercoagulability, which should be observed in the future.

Conclusions

Currently, the data on the prevalence of DVT among inpatients on the Tibetan Plateau in China is limited. Our study findings provide a basis for DVT prevention and treatment in the Tibetan Plateau in the future. Based on our findings, we suggest that medical staff should use an appropriate DVT evaluation model to assess DVT-independent risk factors and prevalence. Based on the outcomes, targeted preventive measures along with plateau characteristics can be applied to reduce the DVT prevalence. During hospitalization, it is important that patients focus on assessing the conditions of their lower extremities.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

DVT:

Deep Venous Thrombosis

DUS:

Duplex Ultrasonography

FDPs:

Fibrinogen Degradation Products

OR:

Odds Ratio

CI:

Confidence Interval

PT:

Prothrombin Time

TT:

Thrombin Time

APTT:

Activated Partial Thromboplastin Time

FIB:

Fibrinogen

References

  1. Huisman MV. Deep venous thrombosis and pulmonary embolism. Semin Respir Crit Care Med. 2012;33(2):125–6.

    Article  PubMed  Google Scholar 

  2. Brill A, Suidan GL, Wagner DD. Hypoxia, such as encountered at high altitude, promotes deep vein thrombosis in mice. J Thromb Haemostasis: JTH. 2013;11(9):1773–5.

    Article  CAS  Google Scholar 

  3. Turpie AGG, Farjat AE, Haas S, Ageno W, Weitz JI, Goldhaber SZ, et al. 36-month clinical outcomes of patients with venous thromboembolism: GARFIELD-VTE. Thromb Res. 2023;222:31–9.

    Article  CAS  PubMed  Google Scholar 

  4. Jha PK, Sahu A, Prabhakar A, Tyagi T, Chatterjee T, Arvind P, et al. Genome-wide expression analysis suggests hypoxia-triggered hyper-coagulation leading to venous thrombosis at high altitude. Thromb Haemost. 2018;118(7):1279–95.

    Article  PubMed  Google Scholar 

  5. Chopard R, Albertsen IE, Piazza G. Diagnosis and treatment of lower extremity venous thromboembolism: a review. JAMA. 2020;324(17):1765–76.

    Article  PubMed  Google Scholar 

  6. Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, et al. editors. ‘s choice - european society for vascular surgery (esvs) 2021 clinical practice guidelines on the management of venous thrombosis. European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery. 2021;61(1):9–82.

  7. Aquila AM. Deep venous thrombosis. J Cardiovasc Nurs. 2001;15(4):25–44.

    Article  CAS  PubMed  Google Scholar 

  8. Liu X, Zhang H, Yan J, Li X, Li J, Hu J, et al. Deciphering the efficacy and mechanism of astragalus membranaceus on high altitude polycythemia by integrating network pharmacology and in vivo experiments. Nutrients. 2022;14(23).

  9. Smallman DP, McBratney CM, Olsen CH, Slogic KM, Henderson CJ. Quantification of the 5-year incidence of thromboembolic events in U.S. Air Force Academy cadets in comparison to the U.S. Naval and Military Academies. Mil Med. 2011;176(2):209–13.

    Article  PubMed  Google Scholar 

  10. Yang H, Yang G, Xu M, Zhao Y, He S, Wang Q, et al. Impact of high altitude on the incidence of postoperative venous thromboembolism and its genetic susceptibility: a meta-analysis and systematic review. Sci Total Environ. 2022;838(Pt 4):156632.

    Article  CAS  PubMed  Google Scholar 

  11. Kicken CH, Ninivaggi M, Konings J, Moorlag M, Huskens D, Remijn JA, et al. Hypobaric hypoxia causes elevated thrombin generation mediated by fviii that is balanced by decreased platelet activation. Thromb Haemost. 2018;118(5):883–92.

    Article  PubMed  Google Scholar 

  12. Yanamandra U, Boddu R, Pramanik S, Mishra K, Kapoor R, Ahuja A, et al. Prevalence and clinical characteristics of post-thrombotic syndrome in high-altitude-induced deep vein thrombosis: experience of a single tertiary care center from real-world settings. High Alt Med Biol. 2020;21(4):319–26.

    Article  CAS  PubMed  Google Scholar 

  13. Ye DP, Zhang SL, Xu QH, Wei LJ. A case of Galen vein thrombosis occurring after bilateral acetabular fractures in the Tibet plateau - what can we learn? Chinese journal of traumatology = Zhonghua Chuang shang za zhi. 2017;20(5):308–10.

  14. Algahtani FH, AlQahtany FS, Al-Shehri A, Abdelgader AM. Features and incidence of thromboembolic disease: a comparative study between high and low altitude dwellers in Saudi Arabia. Saudi J Biol Sci. 2020;27(6):1632–6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gornik HL, Sharma AM. Duplex ultrasound in the diagnosis of lower-extremity deep venous thrombosis. Circulation. 2014;129(8):917–21.

    Article  PubMed  Google Scholar 

  16. Loffredo L, Arienti V, Vidili G, Cogliati C, Battaglia S, Perri L, et al. Low rate of intrahospital deep venous thrombosis in acutely ill medical patients: results from the aurelio study. Mayo Clin Proc. 2019;94(1):37–43.

    Article  PubMed  Google Scholar 

  17. Sun ML, Wang XH, Huang J, Wang J, Wang Y. [Comparative study on deep venous thrombosis onset in hospitalized patients with different underlying diseases]. Zhonghua Nei Ke Za Zhi. 2018;57(6):429–34.

    CAS  PubMed  Google Scholar 

  18. Law Y, Chan YC, Cheng SWK. Epidemiological updates of venous thromboembolism in a Chinese population. Asian J Surg. 2018;41(2):176–82.

    Article  PubMed  Google Scholar 

  19. Yong D, Ma XF, Wang H. Difference in indicators of coagulation function, erythrocyte related index and bilirubin between native tibetan and Han patients with coronary slow flow phenomenon in plateau area: a case-control study. Practical J Cardiac Cereb Pneumal Vascular Disease. 2020;28(3):51–5.

  20. Nordström M, Lindblad B, Bergqvist D, Kjellström T. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med. 1992;232(2):155–60.

    Article  PubMed  Google Scholar 

  21. Lee LH, Gallus A, Jindal R, Wang C, Wu CC. Incidence of venous thromboembolism in Asian populations: a systematic review. Thromb Haemost. 2017;117(12):2243–60.

    Article  PubMed  Google Scholar 

  22. Sime F, Monge C, Whittembury J. Age as a cause of chronic mountain sickness (Monge’s disease). Int J Biometeorol. 1975;19(2):93–8.

    Article  CAS  PubMed  Google Scholar 

  23. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3).

  24. Righini M, Van Es J, Den Exter PL, Roy PM, Verschuren F, Ghuysen A, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014;311(11):1117–24.

    Article  CAS  PubMed  Google Scholar 

  25. Parpia S, Takach Lapner S, Schutgens R, Elf J, Geersing GJ, Kearon C. Clinical pre-test probability adjusted versus age-adjusted D-dimer interpretation strategy for DVT diagnosis: a diagnostic individual patient data meta-analysis. J Thromb Haemostasis: JTH. 2020;18(3):669–75.

    Article  Google Scholar 

  26. Lutsey PL, Zakai NA. Epidemiology and prevention of venous thromboembolism. Nat Reviews Cardiol. 2023;20(4):248–62.

    Article  Google Scholar 

  27. Bukhari S, Fatima S, Barakat AF, Fogerty AE, Weinberg I, Elgendy IY. Venous thromboembolism during pregnancy and postpartum period. Eur J Intern Med. 2022;97:8–17.

    Article  PubMed  Google Scholar 

  28. Huang L, Li J, Jiang Y. Association between hypertension and deep vein thrombosis after orthopedic surgery: a meta-analysis. Eur J Med Res. 2016;21:13.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tang WJ, Shiz X, Zhang CY. Risk factors of deep venous thrombosis in stroke patients: a Meta-analysis. Chin J Nurs. 2019;54(7):989–94.

    Google Scholar 

  30. Wei B, Zhou H, Liu G, Zheng Y, Zhang Y, Hao C, et al. Risk factors for venous thromboembolism in patients with spinal cord injury: a systematic review and meta-analysis. J Spinal Cord Med. 2023;46(2):181–93.

    Article  PubMed  Google Scholar 

  31. Wang S, Wu L. Risk factors for venous thrombosis after spinal surgery: a systematic review and meta-analysis. Comput Math Methods Med. 2022;2022:1621106.

    PubMed  PubMed Central  Google Scholar 

  32. Bauer A, Limperger V, Nowak-Göttl U. End-stage renal disease and thrombophilia. Hamostaseologie. 2016;36(2):103–7.

    Article  PubMed  Google Scholar 

  33. Goldhaber SZ, Tapson VF. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol. 2004;93(2):259–62.

    Article  PubMed  Google Scholar 

  34. Wołkowski K, Wołkowski M, Urbanek T. Venous thromboembolism Prophylaxis and thrombotic risk stratification in the Varicose veins surgery-prospective observational study. J Clin Med. 2020;9(12):3970.

    Article  PubMed  PubMed Central  Google Scholar 

  35. León-Velarde F, Maggiorini M, Reeves JT, Aldashev A, Asmus I, Bernardi L, et al. Consensus statement on chronic and subacute high altitude diseases. High Alt Med Biol. 2005;6(2):147–57.

    Article  PubMed  Google Scholar 

  36. Wu TY. Chronic mountain sickness on the Qinghai-Tibetan plateau. Chin Med J. 2005;118(2):161–8.

    PubMed  Google Scholar 

  37. Gao ZQ, Xie SW, Gao WX. A comparative study on chronic mountain sickness of plateau migrants within ten years. Military Med Sci. 2022;46(2):90–4.

    CAS  Google Scholar 

  38. Timp JF, Cannegieter SC, Tichelaar V, Braekkan SK, Rosendaal FR, le Cessie S, et al. Antibiotic use as a marker of acute infection and risk of first and recurrent venous thrombosis. Br J Haematol. 2017;176(6):961–70.

    Article  CAS  PubMed  Google Scholar 

  39. Schmidt M, Horvath-Puho E, Thomsen RW, Smeeth L, Sørensen HT. Acute infections and venous thromboembolism. J Intern Med. 2012;271(6):608–18.

    Article  CAS  PubMed  Google Scholar 

  40. Shao X, Ren Y, Xie N, Fan K, Sun H, Lu J, et al. Effect of Cefoperazone/Sulbactam on blood coagulation function in infected Emergency Department patients and the necessity of vitamin K1 (VK1) preventive intervention: a Single-Center, retrospective analysis. Med Sci Monit. 2023;29:e939203.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Wang YY, Yu JH, Duan JL. Analysis of influencing factors of coagulation caused by cefoperazone sulbactam. Chin Gen Pract. 2020;23(S1):138–40.

    Google Scholar 

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Acknowledgements

Not applicable.

Funding

This work was supported by the key project of the Qinghai Provincial Health Commission (2019-wjzd-01).

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Author notes

  1. Lijuan Sun and Shiqin Pan contributed equally to this work.

Authors and Affiliations

  1. Department of Nursing, Qinghai Provincial People’s Hospital, No.2 Gonghe Road, Xining, 810000, China

    Lijuan Sun, Shiqin Pan, Yuemei Li, Mingqin Luo, Xiaofang Li, Hongmei Ma & Jingni Zhang

  2. Department of Nursing, The Third People’s Hospital of Xining, Xining, 810006, China

    Limei Wang

  3. Department of Nursing, Yushu People’s Hospital, Yushu, 815000, China

    Cuo Yong

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Conceptualization Lijuan Sun, Shiqin Pan; Data curation: Limei Wang, Cuo Yong, Hongmei Ma; Formal analysis; Funding acquisition: Yuemei Li; Investigation: Xiaofang, Hongmei Ma, Lijuan Sun; Methodology: Shiqin Pan, Jingni Zhang; Project administration: Yuemei Li, Mingqin Luo; Roles/Writing - original draft: Lijuan Sun, Shiqin Pan; Writing - review & editing: Yuemei Li, Mingqin Luo.

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Correspondence to Shiqin Pan.

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All patients in this study provided written informed consent. The study was approved by the ethics committee of Qinghai Provincial People’s Hospital (2020-48). All procedures involving human participants were conducted according to the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All patients in this study provided written informed consent.

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Sun, L., Pan, S., Li, Y. et al. Prevalence and risk factors of deep venous thrombosis of hospitalizations in plateau: a cross-section analysis. J Cardiothorac Surg 19, 441 (2024). https://doi.org/10.1186/s13019-024-02878-6

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Keywords

Journal of Cardiothoracic Surgery

ISSN: 1749-8090

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