利伐沙班和依诺肝素钠对人工全膝关节置换术后失血风险的影响比较

COMPARISON OF RIVAROXABAN AND ENOXAPARIN ON BLOOD LOSS AFTER TOTAL KNEE ARTHROPLASTY

目的比较利伐沙班和依诺肝素钠对人工全膝关节置换术(total knee arthroplasty,TKA)后失血风险的影响。方法回顾分析2010年1月-2012年10月,107例(121膝)接受初次TKA且符合选择标准的膝关节骨关节炎患者临床资料。根据围术期使用抗凝药物不同分为两组,其中利伐沙班组51例(57膝),依诺肝素钠组56例(64膝)。两组患者性别、年龄、身高、体重、体重指数、骨关节炎分级及病程比较,差异均无统计学意义(P>0.05),具有可比性。比较两组围术期实际总失血量、隐性失血量、显性失血量及隐性失血量占实际总失血量百分比,记录术后35 d内的出血事件。结果术后依诺肝素钠组显性失血量显著高于利伐沙班组,隐性失血量占实际总失血量百分比显著低于利伐沙班组,差异均有统计学意义(P<0.05);两组实际总失血量和隐性失血量比较,差异均无统计学意义(P>0.05)。术后35 d内利伐沙班组发生出血事件8例(15.69%),其中切口出血1例,黑便4例,血尿3例;依诺肝素钠组发生出血事件2例(3.57%),其中血尿1例,黑便1例;利伐沙班组出血事件发生率显著高于依诺肝素钠组(χ2=4.624,P=0.032)。结论利伐沙班和依诺肝素钠对TKA术后隐性失血影响无显著差异,但依诺肝素钠会增加显性失血风险。

Objective To compare the effect on blood loss after total knee arthroplasty （TKA） between rivaroxaban and enoxaparin. Methods A retrospective analysis was made on the clinical data of 107 patients （121 knees） with osteoarthritis undergoing primary TKA between January 2010 and October 2012. According to different perioperative anticoagulants, the patients were divided into the rivaroxaban group （51 cases, 57 knees） and the enoxaparin group （56 cases, 64 knees）. There was no significant difference in gender, age, height, weight, body mass index, osteoarthritis classification, and disease duration between 2 groups （P 〉 0.05）. The total blood loss, hidden blood loss, dominant blood loss, and the percentage of hidden blood loss were compared between 2 groups. The bleeding events were recorded within 35 days after operation. Results The dominant blood loss of enoxaparin group was significantly higher than that of rivaroxaban group （t=3.025, P=0.003）, but the percentage of hidden blood loss of enoxaparin group was significantly lower than that of rivaroxaban group （t=4.361, P=0.000）; no significant difference was found in the total blood loss and hidden blood loss between 2 groups （P 〉 0.05）. The incidence of bleeding event in rivaroxaban group （15.69%; including 1 case of incision bleeding, 4 cases of melena, and 3 cases of haematuria） was significantly higher than that in enoxaparin group （3.57%; including 1 case of haematuria and 1 case of melena） （χ^2=4.624, P=0.032）. Conclusion Rivaroxaban does not increase the risk of hidden blood loss for TKA when compared with enoxaparin, but enoxaparin can increase the risk of dominant blood.