利伐沙班预防老年股骨近端骨折合并脑梗死经人工股骨头置换后静脉血栓栓塞症的效果

Prevention against venous thromboembolism after hip replacement by rivaroxaban in elderly patients with femur proximal fracture combined with cerebral infarction

目的:评价延长疗程应用利伐沙班或联合阿司匹林预防人工股骨头置换治疗老年股骨近端骨折合并脑梗死(cerebral infarction,CI)后静脉血栓栓塞症(venous thromboembolism,VTE)的有效性及安全性。方法:30例经人工股骨头置换治疗股骨近端骨折合并CI的老年患者,分为3组(n=10),于术后当日起分别口服利伐沙班10 mg 1/d,35 d,口服利伐沙班10 mg 1/d+阿司匹林100 mg 1/d,35 d,皮下注射那屈肝素0.4 mL 1/d,14 d。结果:PT、APTT、Fib、Hb、PLT变化水平、术后48 h Hb下降≥2 g/dL发生率组间无统计学意义;术后3月利伐沙班、利伐沙班与阿司匹林联合组未见VTE(DVT)发生,未见新发出血性CI发生。结论:延长疗程应用利伐沙班或联合阿司匹林在预防人工股骨头置换治疗老年股骨近端骨折合并CI后VTE安全有效,不增加出血性CI风险。

Objective To evaluate the efficacy and safety of prolonged treatment with rivaroxaban alone or with rivaroxaban combined with aspirin in the prevention against venous thromboembolism （VTE） after hip replacement in elderly patents with femur proximal fracture plus cerebral infarction （CI）. Methods 30 elderly patients with femur proximal fracture plus CI, receiving artificial femoral head replacement, were divided into 3 groups （each n = 10） ： Group A received 10mg of rivaroxaban tablets orally once a day for 35 days; Group B received 10 mg of rivaroxaban plus 100mg of aspirin tablets orally once a day for 35 days; Group C received hypodermic injection with 0.4 mL of nadroparin once a day for 14 days. Results Levels of PT, APTY, Fib, Hb, PLT, and the incidence of the decrease of 2 g/dL of Hb 48 hours after surgery were not significantly different among the three groups. VTE and hemorrhagic CI were not found 3 months after surgery in the three groups. Conclusion Prolonged treatment with rivamxaban alone or with rivaroxaban combined with aspirin could effectively and safely prevent VTE after hip replacement in elderly patients with femur proximal fracture plus CI, and didn＇t increase the risk for hemorrhagic CI.