利伐沙班与低分子肝素对骨折患者下肢深静脉血栓预防的疗效比较

A comparative study of efficacy between rivaroxaban and low molecular weight heparin on preven- ting deep vein thrombosis in patients with lower limb fractures

目的比较利伐沙班与低分子肝素对下肢骨折患者下肢深静脉血栓形成（DVT）的预防作用，评价两种药物对预防下肢骨折患者术后下肢DVT的有效性和安全性。方法对符合纳入标准的205例下肢骨折患者随机分为年龄、性别、骨折部位均衡的低分子肝素组（L组，107例）和利伐沙班组（R组，98例）。两种药物均按照用药规范进行围手术期抗凝治疗。术前及术后彩超检查评价DVT的发生，观察并记录皮肤黏膜及皮下出血情况，术后切口引流量，比较术前和术后血红蛋白下降水平。结果两组中术后均未出现严重性出血病例。L组DVT发生率11．21％，皮肤黏膜出血发生率14．02％；R组DVT发生率4．08％，皮肤黏膜出血发生率7．14％；组间差异均有统计学意义（P〈0．05）。L组术后引流量和血红蛋白下降水平分别为（394．6±68．3）rnl和（18．2±5．2）ml（n=107），R组术后引流量和血红蛋白下降水平分别为（389．2±59．7）ml和（17．8±3．8）ml（n=98），组间差异均无统计学意义（P〉0．05）。结论利伐沙班对于预防下肢骨折患者下肢DVT的有效性和安全性方面优于低分子肝素，且利伐沙班口服给药更为方便，患者依从性更高。

Objective To compare the preventive effects of low molecular weight heparin （LMWH） and rivaroxaban for deep vein thrombosis （DVT） in lower limb fractures. Methods A retro- spective cohort study was performed on 205 patients with lower limb fractures and eligible for our preposi- tive standards from June 2012 to June 2015. All patients were randomly divided into two main groups ac- cording to their age, sex, and locations of fracture： LMWH group （L group, 107 cases） and rivaroxaban group （R group, 98 cases）. Two drugs were given to patients according to the present guidelines to prevent DVT at the perioperative period. Color Doppler ultrasound was used to identify DVT before and after the operation. Other data including subcutaneous hemorrhage, postoperative drainage volume, and decrease of hemoglobin level postoperatively were also recorded. Results No severe bleeding cases were recorded in the two groups. The incidences of postoperative DVT and subcutaneous hemorrhage in L group were 11.21% and 14. 02% respectively, and 4. 08% and 7. 14% respectively in R group. There were signifi- cant differences between two groups in the incidences of DVT and subcutaneous hemorrhage. While the postoperative drainage volume and decrease of hemoglobin level in L group were （ 394. 6 ± 68.3 ） ml and （ 18.2± 5.2） ml （ n = 107 ） respectively, and （389. 2 ± 59. 7 ） ml and （ 17.8 ± 3.8 ） ml （ n = 98 ） respectively in R group. No significant differences were detected between the two groups in the postoperative drainage volume and decrease of hemoglobin level. Conclusion Rivaroxaban can reduce the incidence of DVT without increasing bleeding in patients with lower limb fractures, and can be used for preventing peri- operative DVT in patients with lower limb fractures.