髋膝关节置换围手术期下肢深静脉血栓形成与D-二聚体及抗凝药的关系

Value of D-dimer in detection of perioperative deep venous thrombosis and effects of anticoagulants following total hip/knee arthroplasty

目的探索髋膝关节置换围手术期下肢深静脉血栓形成与D-二聚体升高关系及使用不同抗凝药的有效性和安全性评估。方法前瞻性分析70例行髋膝关节置换的患者,根据术后双下肢彩色多普勒超声结果,分为血栓组(11例)和非血栓组(59例),记录两组在术前及术后D-二聚体浓度并进行统计分析。同时按照使用抗凝药不同分为低分子肝素(速碧林)预防组和利伐沙班预防组,记录并比较二者DVT发生率和术后伤口引流量关系。结果血栓组术前D-二聚体浓度与非血栓组术前D-二聚体的浓度相比较有显著性差异(P<0.01),血栓组较非血栓组增高。血栓组与非血栓组术后第7天的D-二聚体浓度比较则无显著性差异(P>0.05),血栓组与非血栓组各自组内比较,术后与术前的D-二聚体浓度比较均有显著性差异(P<0.01),术后浓度较术前均有增高。在使用抗凝药物情况下DVT的发病率为15.71%,利伐沙班与低分子肝素(速碧林)干预后DVT发生的情况无显著性差异(P>0.05)。术后伤口引流量无统计学差异(P>0.05)。结论研究发现D-二聚体对DVT预测不是特异性指标;髋膝关节置换术后使用抗凝药物情况下DVT发生情况明显下降,利伐沙班与低分子肝素对于预防DVT作用上无显著性差异。

Objective To explore the relationship between D-dimer and the perioperative deep vein thrombosis （ DVT） and to analyze the efficacy and safety of rivaroxaban versus low molecular weight＆amp;nbsp;heparin （LMWH） for the prevention of DVT after primary total hip or knee arthroplasty .Methods A prospective analysis was carried out on 70 patients.The patients were divided into two groups according to the results of ultrasound for bilateral venae profundae of both the lower extremities on the 7th day after the surgery： the thrombus group and the non-thrombus group . The preoperative and postoperative concentrations of D-dimer were detected and analysed .Meanwhile all the patients were divided into the rivaroxaban group and the LMWH group according to the anticoagulants that were adopted .The incidence of DVT and the drainage volume of the two groups were measured and compared respectively .Results There was significant difference in the preoperative concentration of D-dimer between the thrombus group and the non-thrombus group （ P〈0.01） and there was no significant difference in the postoperative concentration of D-dimer 7 days after the operation between the two groups （P〉0.05）.Comparing the preoperative and the postoperative concentrations of D-dimer, there were significant differences in both the thrombus group and the non-thrombus group （ P〈0.01 ） .The postoperative concentration of D-dimer was significantly higher than the preoperative one in both the two groups .As all the patients were taking anticoagulant drugs , the incidence of DVT was 15.71%.There was no significant difference in the incidence of DVT between the rivaroxaban group and the LMWH group （ P 〉0.05 ）; also there was no significant difference in the drainage volume of the two groups （ P〉0.05 ） .Conclusions D-dimer is not a specific indicator for the prediction of DVT .The incidence of DVT may decrease significantly when using anticoagulant drugs after primary total hip or knee arthroplasty .The effecacy of DVT prevention shows no difference in rivaroxaban and LMWH.