利伐沙班对人工全髋关节置换术后出血风险的影响

IMPACT OF IVAROXABAN ON HEMORRHAGE RISK AFTER PRIMARY TOTAL HIP ARTHROPLASTY

目的研究利伐沙班对人工全髋关节置换术(total hip arthroplasty,THA)后出血风险的影响。方法2007年12月—2011年6月将符合选择标准的99例初次行THA的患者根据用药不同分为2组,其中利伐沙班组49例,对照组50例。2组手术由同一组医师完成,术前准备、手术操作均一致。利伐沙班组每天口服利伐沙班10mg从术后第1天开始服用至第14天;对照组于相同时间点应用安慰剂。分别于术前第2天及术后第2天行血常规检查,根据公式计算得出总失血量和血红蛋白(hemoglobin,HGB)下降量;分别记录术中失血量、术后切口引流量及拔管后伤口渗液量,得出显性失血量;记录术后30d内的出血事件。结果利伐沙班组失血总量及HGB下降量分别为(1 097.34±211.05)mL及(34.09±5.01)g/L,对照组分别为(10 204.33±251.02)mL及(30.99±5.95)g/L,差异无统计学意义(P>0.05)。利伐沙班组术后显性失血量为(461.02±132.92)mL,明显高于对照组的(345.93±95.91)mL(P<0.05)。术后30 d内利伐沙班组发生出血事件4例(8.1%),对照组仅发生2例(4.0%),差异无统计学意义(P>0.05)。结论利伐沙班对THA术后出血有一定影响,但与安慰剂比较差异无统计学意义。

Objective To analyze the effect of ivaroxaban on the bleeding risk after total hip arthroplasty （THA）. Methods Eighty-nine patients undergoing primary THA between December 2007 - June 2011 were retrospectively analyzed. Depending on the medication, the patients were randomly divided into the control group （50 cases） and the rivaroxaban group （49 cases）. The operative procedures of two groups were concordant. In the rivaroxaban group, rivaroxaban 10 mg/d was taken orally and placebo given in the control group at 1 - 14 days after THA. The blood routine examination was performed before operation and at two days postoperatively ; the hemoglobin （ HGB ） decrease and total blood loss were calculated according to the formula;the blood loss, postoperative wound drainage, and wound exudate after extubation were recorded to calculate the dominant amount of blood loss;and the bleeding ＇events were recorded within 30 days postoperatively. Results The total blood loss and HGB decrease in the rivaroxaban group were （1 097.34 ± 211.05 ）mL and （34.09 ± 5.01 ） g/L and thos~ in the control group were （ 10 204.33 ± 251.02） mL and （ 30.99 ± 5.95 ） g/L, there were no significant difference （ P 〉 0. 05 ） ;the postoperative dominant blood loss in the rivaroxaban group was （461.02 ± 132. 92） mL and that in the control group bleeding events occurred control group, showing no on the bleeding risk after was （345.93 ±95.91 ） mL,there was significantly difference （P〈0.05 ）. The in 4 cases （8.1%） of the rivaroxaban group and in 2 cases （4. 0% ） of the significant difference （ P 〉 0.05 ）. Conclusion Rivaroxaban has some effects THA. In general, rivaroxaban is safe.