比较低分子肝素与利伐沙班对创伤骨折患者深静脉栓塞的预防

Comparison of Low Molecular Weight Heparin and Rivaroxaban for Prevention of Deep Vein Thrombosis in Patients with Traumatic Fractures

目的评估低分子肝素与利伐沙班预防创伤骨折患者下肢深静脉栓塞(DVT)的疗效和安全性。方法将117例骨折患者按随机数字表法分为LHG组(61例)和RG组(56例),分别采用低分子肝素、利伐沙班进行DVT的预防。2组均于入院后、术前1 d及术后1周进行下肢彩色多普勒检查,观察DVT发生情况;以D-聚体的变化作为预防效果的监测指标,同时观察患者皮肤、黏膜出血等不良事件及切口愈合情况。结果 LHG组发生DVT 13例,出血12例,切口愈合不佳1例。RG组发生DVT 5例,出血3例,切口愈合不佳8例。RG组DVT发生率低于LHG组(8.9%比21.3%,P<0.05),出血发生率亦低于LHG组(5.3%比19.7%,P<0.05),而切口并发症发生率高于LHG组(14.3%比1.6%,P<0.05)。结论利伐沙班预防骨折患者DVT的效果和安全性优于低分子肝素,但其切口愈合不佳发生率较高。

Objective To evaluate the efficacy and safety of low molecular weight heparin and rivaroxaban in the prevention of deep vein thrombosis （DVT） in patients with traumatic fractures. Methods A total of 117 patients with traumatic fractures were randomly assigned to receive low molecular weight heparin （LHG group,n=61）or rivaroxaban （RG group,n=56）for the prevention of DVT. Color Doppler examination of lower limbs was performed to observe the occurrence of DVT after hospital admission, 1 day before operation and 1 weeks after operation. The changes in D-dimmer levels were used as the monitoring index of preventive efficacy. In addition, skin and mucous membrane bleeding and incision healing were observed in both groups. Results In LHG group, DVT occurred in 13 patients, bleeding in 12, and poor incision healing in 1. In RG group, DVT occurred in 5 patients, bleeding in 3, and poor incision healing in 8. Compared with LHG group, the incidence of DVT and bleeding decreased but the incidence of incision complications increased in RG group （8.9% vs 21.3%, 5.3%vs 19.7%and 14.3%vs 1.6%, respectively; P〈0.05）. Conclusion The rivaroxaban provides better efficacy and safety but leads to higher incidence of poor incision healing than low molecular weight heparin for the prevention of DVT in patients with traumatic fractures.