阿司匹林和利伐沙班预防全膝关节置换后下肢深静脉血栓形成(英文)

Administration of aspirin and rivaroxaban prevents deep vein thrombosis after total knee arthroplasty

背景:现中国临床上常用抗凝药物为利伐沙班,但有效预防静脉血栓栓塞性疾病的同时,围手术期出血性并发症发生率也明显增加。有研究表明阿司匹林对深静脉血栓形成和肺栓塞具有良好预防效果,但对于能否将其作为全膝关节置换后预防静脉血栓栓塞性疾病的常规用药至今存在争议。目的:观察比较阿司匹林和利伐沙班预防全膝关节置换后下肢深静脉血栓形成的疗效和安全性。方法:初次行单侧全膝关节置换的324例骨关节炎患者随机等分为3组,于置换后12 h,分别用利伐沙班,低分子肝素,阿司匹林干预治疗14 d。所有患者均随访4周。结果与结论:与低分子肝素组相比,利伐沙班组深静脉血栓发生率降低(P<0.05),隐性失血量及切口并发症率升高(P<0.05)。与低分子肝素相比,阿司匹林组深静脉血栓发生率、隐性失血量、切口并发症率、下肢肿胀率和皮下瘀斑率差异均无显著性意义(P>0.05)。结果证实,利伐沙班拥有较强抗凝效果,但并发症发生率高。阿司匹林与低分子肝素相比疗效和安全性均无差异。阿司匹林作为全膝关节置换后多模式抗凝治疗的一部分,安全有效。

BACKGROUND：To date, rivaroxaban has been a clinical y common anticoagulant in China;however, effective prophylaxis for venous thrombosis is associated with a markedly higher incidence of perioperative hemorrhagic complications. Although it has been reported that aspirin effectively prevents deep vein thrombosis and pulmonary embolism, the use of aspirin as a routine drug for venous thrombosis after total knee arthroplasty is stil controversial. OBJECTIVE：To compare the efficacy and safety of aspirin and rivaroxaban for prevention of deep vein thrombosis after total knee arthroplasty. METHODS：Total y 324 patients with osteoarthritis who underwent primary unilateral total knee arthroplasty were randomly divided into three groups. Twelve hours after the surgery, three groups were given aspirin, rivaroxaban and low-molecular-weight heparin respectively. Al three groups were treated for 14 days, and al of the patients were fol owed for 4 weeks. RESULTS AND CONCLUSION：Compared with the low-molecular-weight heparin group, the incidence of deep vein thrombosis was lower （P0.05）. The results confirmed that rivaroxaban has a positive anticoagulation effect but leads to increases in wound complications in patients;there are no differences in efficacy and safety between aspirin and low-molecular-weight heparin, so aspirin as part of a multimodal anticoagulation therapy after total knee arthroplasty has good clinical safety and efficacy.