利伐沙班与低分子肝素预防腰椎手术后下肢深静脉血栓的疗效对比

Compare prophylactic effects of rivaroxaban with low molecular weight heparin on deep vein thrombosis after lumbar surgery

目的比较利伐沙班与低分子肝素预防腰椎手术后下肢深静脉血栓(DVT)的疗效及安全性。方法择期腰椎手术的DVT高危患者142例,随机分为两组。利伐沙班组术后6 h开始口服利伐沙班10 mg,qd;低分子肝素组术后12 h皮下注射低分子肝素5 000 IU,qd;均于患者下床行走后停药。记录术后48 h引流量,手术前及术后7 d检测血D-二聚体水平、凝血酶原时间和活化部分凝血活酶时间。术后7 d行双下肢血管超声检查,观察下肢DVT形成情况。结果两组均无大的下肢DVT形成及肺栓塞发生。利伐沙班组术后48 h引流量(174.3±26.1)mL,低分子肝素组为(167.4±24.2)mL,组间无显著差异(P>0.05)。术后7 d,利伐沙班组发生肌间静脉血栓8例,低分子肝素组9例,组间无显著差异(P>0.05)。两组D-二聚体水平、凝血酶原时间和活化部分凝血活酶时间差异均无显著意义(P>0.05),均无消化道黏膜出血、硬膜外血肿及切口血肿发生。结论利伐沙班可以有效预防腰椎手术后下肢DVT的发生,疗效与低分子肝素相当且安全。

AIM To compare the the efficacy and safety of rivaroxaban with low molecular weight heparin （LMWH） in preventing deep venous thrombosis （DVT） after lumbar surgery. METHODS One hundred and forty- two DVT high- risk patients who had undergone lumbar elective surgery were randomly divided into two groups. The rivaroxaban group was given rivaroxaban 10 mg 6 hours after surgery, po, qd, till out of bed to walk. The LMWH group was given LMWH subcutaneously 5 000 IU 12 h after surgery, qd, till out of bed to walk. Postoperative drainage, the levels of D- dimer, prothrombin time （PT） and activated partial thromboplastin time （APTr） were detected. The formation of DVT was observed 7 d postoperatively by checking the lower extremity vascular ultrasound. RESULTS There were no serious DVT of lower extremity and pulmonary embolism in both groups. The drainage of 48 hours postoperatively in the rivaroxaban group and LMWH group showed no significant difference （（174.3 ＋- 26.1） mL vs. （167.4 ＋ 24.2） mL, P 〉 0.05）. Eight patients occurred myenteric vein thrombosis in rivaroxaban group and nine patients in the LMWH group （P 〉 0.05）. There were no significant difference in levels of D-dimer, PT and APTY between two groups （P 〉 0.05）. No digestive Rivaroxaban LMWH. tract bleeding, is effective in epidural hematoma and wound hematoma occurred in both groups. CONCLUSION preventing DVT of the lumbar surgery, and its efficacy and safety is similar to the