Association between hypertension and deep vein thrombosis after orthopedic surgery: a meta-analysis
DVT was detected in % of the studied hypertensive patients. Increased age and gender had no significant association with the development of DVT among. Because approximately 3 of every 4 pulmonary embolism and DVT events occur Furthermore, there is a relationship between VTE that occurs in the community and Hypertension had a relative risk of for idiopathic PE. The association between hypertension and DVT after orthopedic surgery was assessed by pooled odds ratios (ORs) and 95 % confidence.
Over the past several years, studies on the association between DVT and hypertension have been reported, but the results are inconsistent. Some studies verified that hypertension could increase the development of DVT [ 1112 ]. However, Wang et al. Therefore, the controversial issue remains to be investigated. Thus, in the current study, we performed a meta-analysis of available eligible studies to better elucidate the association between hypertension and DVT after orthopedic surgery.
Methods The paper did not involve any human or animal study, so the ethical approval was not required. Literature search We searched electronic databases PubMed http: The search terms were hypertension or high blood pressure or HBP; deep vein thrombosis or thrombose veineuse profonde or DVT or deep venous thrombosis; orthopedic post-operation or orthopedic or orthopaedic and postoperative.
Language restrictions were not used for the search. Study selection Studies were included if they met the following criteria: Studies were excluded if they were reviews, reports, or letters.
Data extraction With the standard protocol, two investigators independently extracted the following data from the included studies: Disagreements were resolved through discussion or settled by a third reviewer. Statistical analysis Meta-analysis was carried out using R 3. Heterogeneity test was evaluated by Chi-square based on Q statistic [ 15 ] and I2 statistics [ 16 ]. A sensitivity analysis was performed, in which one study was removed at a time and others were analyzed to examine the influence of a single study on the combined OR value [ 18 ].
A P value less than 0. Materials and Methods 2. Rats exposed to the stress protocol were individually placed into a foot shock stress box, where they received a 4-hour session of electrical foot shock through an electrified grid floor delivering a 5-second long 0.
After a one-week recovery period, the foot shock protocol was started. Briefly, the abdomen was opened, and the inferior vena cava IVCafter being carefully separated from the surrounding tissues, was ligated tightly just below the left renal vein using a cotton thread.
Then, the abdomen was closed with a double layer of sutures, closing the peritoneum with muscles first and then the skin separately.
Deep vein thrombosis - Symptoms and causes - Mayo Clinic
After twelve hours, the animals were anaesthetized again, the abdomen was reopened, and the plasma and thrombus were collected for further analysis [ 2 ]. All surgical procedures were approved by the Soochow University and performed in accordance with the guidelines for the care and use of animals established by the Soochow University.
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- Association between hypertension and deep vein thrombosis after orthopedic surgery: a meta-analysis
Thrombus Weight Measurements From the reopened abdominal cavity, the ligated segment of the vena cava was removed and opened longitudinally to remove the formed thrombus, which was rinsed and weighed on filter paper. From the reopened abdominal cavity, blood 4.Hypertension Nursing NCLEX Review
Half of the blood was centrifuged at rpm for 10 min and the serum was collected. After preheating for 20 min, the PT was measured using an automated blood coagulation analyzer, as mentioned above. Platelet aggregation was measured using a platelet aggregation analyzer Chrono-Log Ca, Germany. After the cavity was reopened, 4.
The second half of the blood was centrifuged at rpm for 10 min to obtain the platelet-rich plasma. The blood remaining in the tube was centrifuged at rpm for 10 min to prepare the platelet-poor plasma. Then, coagulation of the plasma samples was stimulated using collagen protein and adenosine diphosphate disodium ADP 1 mM, 10 mL as platelet agonists.
Effect of Shock, Denervation, and Tempol Treatment on the Plasma Corticosterone Concentrations Plasma corticosterone levels the marker of stress were markedly increased in the foot shock group when compared with the control groupFigure 1 and were markedly suppressed in both the denervation plus shock and the Tempol plus shock groups compared with the foot shock alone groupFigure 1. This result indicated that chronic foot shock significantly increased plasma corticosterone when the body was under stress, and both of denervation and Tempol treatment could alleviate the stress state.
Plasma concentrations of corticosterone. Concentrations of corticosterone in plasma in each group after two-week stress were measured as described in Materials and Methods section.
In the foot shock group, the thrombus weight was significantly increased compared with that of the control groupFigure 2. However, the thrombus weight of the denervation plus shock and Tempol plus shock groups remained unchanged compared with the control group thrombi but was significantly decreased compared with the foot shock group thrombiFigure 2.
These results suggest that chronic shock could facilitate the formation of DVT, while both denervation and Tempol treatment could inhibit stress-induced increase of DVT formation. There was a significant difference in the PT, TT, and platelet aggregation parameters between the control and the foot shock groups.
The PT of the foot shock group was lower than that of the control group; however, the TT and platelet aggregation parameters were higher in the foot shock group compared with the control group.
In parallel, a significant decrease was observed in the TT and platelet aggregation parameters of the denervation plus shock and Tempol plus shock groups compared with the foot shock groupTable 1 and Figure 3. These results reveal that chronic shock could enhance coagulation system by activation of platelet aggregation. Platelet aggregation rate stimulated by ADP a, b and platelet aggregation rate stimulated by collagen c, d were measured in each group after two-week stress as described in Materials and Methods section through platelet aggregation analyzer.
The plasma NA levels in the denervation plus shock and Tempol plus shock group were significantly suppressed compared with the foot shock groupFigure 4. These results confirm the success of the renal denervation surgical procedure. Plasma concentrations of noradrenaline.
Concentrations of noradrenaline in plasma in each group after two-week stress were measured as described in Materials and Methods section. The plasma SOD activity in the denervation plus shock and Tempol plus shock groups was markedly elevated compared with the foot shock groupFigure 5 a. The plasma GSH-Px activity in the foot shock group was also markedly higher than that of the control groupFigure 5 b.
The plasma GSH-Px activity in the denervation plus shock and Tempol plus shock groups was markedly elevated compared with the foot shock groupFigure 5 b.
Foot shock led to a marked increase in the levels of plasma thiobarbituric acid reactive substances TBARS compared with control groupFigure 5 c. The plasma TBARS levels in the denervation plus shock and Tempol plus shock groups were markedly suppressed compared with the foot shock groupFigure 5 c. Discussion In this study, we identified that DVT formation is facilitated under stress conditions and that changes in the blood coagulation system are induced by stress.
Oxidative Medicine and Cellular Longevity
Accumulating data have shown that chronic psychological stress activated two systems: As shown in the data, the corticosterone levels of chronic shock group were significantly increased, indicating that HPA was activated. What is the role of sympathetic nerve system in response to stress? Since it has been demonstrated that renal sympathetic system activation is highly related to the development of hypertension, and renal denervation is a new treatment in clinical for refractory hypertension patients [ 26 ], renal sympathetic system must play an important role in cardiovascular diseases.
In addition, recent observations show that high stress condition is highly related to cardiovascular diseases [ 4 ] especially cardiac and brain infarction; therefore, we speculate whether chronic stress will activate coagulation system through activation of renal sympathetic nerve system.
In the present study, we firstly found that chronic stress could aggregate the DVT formation, suggesting that stress will increase the risk of cardiovascular diseases.
Our data showed that there was a significant change in platelet aggregation induced by both ADP and collagen suggesting that the aggravating effect of stress on DVT formation was mediated by activation of platelet. Our results firstly reveal the mechanism which links the high stress condition and cardiovascular diseases. Although our present data clearly demonstrated the role of renal sympathetic nerve system in the chronic shock induced development of DVT, it is hard to identify whether afferent or efferent nerve plays a major role due to the limitation of surgical procedure.
We speculate that both are involved in; the reason is that afferent nerve could affect neurogenic control of blood pressure which may contribute to the development of DVT; and efferent nerve could regulate renal secretion of noradrenaline which may also contribute to the development of DVT. The presence of damaged endothelium and activated clotting factors or platelets facilitates the development and progression of DVT [ 27 ].
In the present study, we focused mainly on platelet function in DVT. The phenomena of platelet adhesion, release, or aggregation are also known as platelet activation [ 29 ].
Activated platelets play an important role in the thrombosis process. Our data show that platelet aggregation increased after stress treatment, along with the enhancement in DVT formation. The platelet count was used to normalize the measure of platelet activity; however, no statistics on the number of platelets in each group were performed. Our analyses of the plasma GSH-Px and SOD activity, as well as the plasma TBARS level, showed that the body is in a state of oxidative stress induced by chronic foot shock treatment, which was inhibited by renal denervation.
Therefore, we can say that the renal sympathetic innervation directly increases oxidative stress levels. It has been reported that platelet aggregation, an additional risk factor for thrombus, is associated with oxidative stress [ 32 ]. Oxidative stress could directly increase platelet aggregation through oxygen-free radicals located on the platelet surface [ 32 ]. Solid evidence has demonstrated that oxidative stress could directly activate platelets through a variety of ways.