利伐沙班(Rivaroxaban)预防腰椎术后静脉血栓形成的疗效观察

The curative effect of thromboprophylaxis with rivaroxaban after lumbar surgery

目的观察利伐沙班在腰椎术后预防静脉血栓形成的临床疗效。方法自2011-10-2013-12期间在我院行腰椎手术的患者,根据骨科手术静脉血栓栓塞症危险分度选择具有高度或极高度风险的患者共156例,于术后6 h开始口服利伐沙班10 mg,以后每问隔24 h口服10 mg,直至术后2周。于前次口服利伐沙班18 h后即下次用药前6 h拔出引流管。抗凝治疗期间观察患者肺栓塞、下肢深静脉血栓发生率及出血性事件、不良反应发生情况。结果所有入选患者均完成2周利伐沙班抗凝治疗,期间无症状性静脉血栓形成事件发生。拔除引流管时间为术后(37.4±9.6)h,平均引流量为(220±160.4)ml。除3例患者出现切口淤斑,2例出现切口渗血外无大出血事件发生;7例患者出现轻度转肽酶、转氨酶升高,2例出现轻度皮肤瘙痒、红斑等局部过敏反应。结论利伐沙班可有效的预防具有高度或极高度静脉血栓形成风险的腰椎术后患者静脉血栓事件的发生,并且相关的不良反应发生率较低。

Objective To observe the effect 6f thromboprophylaxis with rivaroxaban after lumbar surgery. Methods From October 2011 to December 2013,156 patients who had undergone lumbar surgery with high or very high risk of venous thrombosis follow the guide were selected. All pa- tients started to oral rivaroxaban at 6 hours after surgery and subsequently once every 24 hours until two weeks after operation. The drainage tube was removed 6 hours prior to the rivaroxaban administration. The occurrences of pulmonary embolism,deep venous thrombosis,bleeding complications and side effects were recorded. Results All patients were cured two weeks in the study. No symptomatic venous thromboembolism and major bleeding events occurred. The average time of removing drainage tube was （37.4±9.6） hours after operation,and the mean total drainage volume was （220±160.4） ml. Incision site eechymosis occurred in 3 patients, incision bleeding in 2 patients, transpeptidase and hepatic aminotransferase levels in 7 patients were observed mild eleva- tion, mild itch and erythema in 2 patients. Conclusion It is effective and safe to prevent venous thromboembolism with rivaroxaban for patients with high or very high risk of venous thrombosis after lumbar surgery.