利伐沙班预防老年患者髋关节置换术后深静脉血栓效果观察

Effect of rivaroxaban on preventing deep venous thrombosis after hip arthroplasty in elderly patients

目的探讨行髋关节置换术老年患者应用利伐沙班预防术后深静脉血栓形成（deep vein thrombosis,DVT）的效果。方法初次行髋关节置换术老年患者145例,依据术后用药分为利伐沙班组75例与肝素组70例。利伐沙班组于术后6~8h口服利伐沙班10mg/次,1次/d;肝素组于术后12~14h腹壁皮下注射低分子肝素0.4mL/次,1次/d,2组均连续应用10d。术后第11天行彩超检查观察2组DVT形成情况,比较2组术后切口出血发生率、引流量、血小板计数、活化部分凝血酶时间（activated partial thromboplastin time,APTT）、凝血酶原时间（prothrombin time,PT）水平。结果利伐沙班组术后发生DVT 5例（6.7%）,切口出血2例（2.7%）,术后引流量（148.3±20.1）mL,血小板计数（223.0±13.1）×109/L,ATPP（35.4±7.8）s,PT（12.6±0.9）s;肝素组术后发生DVT 6例（8.6%）,切口出血3例（4.3%）,术后引流量（155.0±29.3）mL,血小板计数（219.5±12.2）×109/L,ATPP（36.7±8.9）s,PT（12.4±1.1）s,2组比较差异均无统计学意义（P〉0.05）。结论利伐沙班预防老年患者髋关节置换术后DVT形成的效果与低分子肝素相当,但利伐沙班可口服给药,患者依从性高。

Objective To investigate the preventive effect of rivaroxaban on deep vein thrombosis（DVT）after hip arthroplasty in the elderly patients.Methods A total of 145 elderly patients receiving primary hip arthroplasty were divided into two groups according to the postoperative administration.Rivaroxaban group（n=75）was given oral rivaroxaban 10 mg 6to 8hours after operation,and low molecular weight heparin（LMWH）group（n=70）was given subcutaneous injection of LMWH 0.4mL 12 to 24hours after operation,once a day,totally for 10 days.The DVT formation was detected by color Doppler ultrasound and the incidence of postoperative hemorrhage,postoperative drainage volume,platelet count,activated partial thromboplastin time coagulation test（APTT）and prothrombin time（PT）were compared between two groups after treatment for 10 days.Results DVT occurred in 5patients（6.7%）,incision hemorrhage occurred in 2patients（2.7%）,the postoperative drainage volume was（148.3±20.1）mL,platelet count was（223.0±13.1）×109/L,ATPP was（35.4±7.8）s and PT was（12.6±0.9）s in rivaroxaban group.DVT occurred in 6patients（8.6%）,incision hemorrhage occurred in 3patients（4.3%）,the postoperative drainage volume was（155.0±29.3）mL,platelet count was（219.5±12.2）×109/L,ATPP was（36.7±8.9）s and PT was（12.4±1.1）s in LMWH group,showing no significant difference in comparison with rivaroxaban group（P〉0.05）.Conclusion Rivaroxaban has the similar effect on preventing the formation of DVT as LMWH,and oral administration of rivaroxaban has a good patient compliance.