利伐沙班与华法林在合并糖尿病老年髋部骨折术后预防深静脉血栓形成的对比

Comparision of rivaroxaban and warfarin on preventing post-operation deep vein thrombosis in elderly hip fracture patients with diabetesmellitus

目的 观察利伐沙班与华法林在合并糖尿病老年髋部骨折患者术后预防深静脉血栓（deep venous thrombosis,DVT）形成的疗效。方法 将168例合并糖尿病老年髋部骨折患者随机分成观察组88例和对照组80例。观察组患者于术后予以利伐沙班10mg口服,1次/天;对照组在术后给予华法林联合低分子肝素治疗,均持续用药14d。分别于术后第7、14、21、28天行彩色多普勒超声评估患肢深静脉血流和DVT形成情况,并观察治疗期间D-二聚体水平及出血情况。结果 对照组术后第7天即有患者发生DVT,总发生例数7例（8.75%）,显著高于观察组的2例（2.23%）。观察组术后7d D-二聚体水平已明显降低,而对照组则在术后第14天D-二聚体水平才有显著下降（P〈0.05）。观察组总出血例数1例（1.14%）,显著低于对照组的4例（5.0%）,差异具有统计学意义（P〈0.05）。结论 利伐沙班较华法林可更有效地预防合并糖尿病老年髋部骨折患者术后DVT形成,出血风险显著降低,更为安全与方便。

Objective To compare the clinical effects between rivaroxaban and warfarin on preventing deep vein thrombosis （DVT） in elderly hip fracture patients with diabetes mellitus （DM） after operation. Methods One hundred and sixty-eight elderly hip fracture patients with DM were randomly divided into the observation group and the control group. The observation group （88 cases） were treated with rivaroxaban （10mg, po, qd） after surgery, and the control group were treated with warfarin and low molecular weight heparin calcium for 14 days. Respectively after 7,14,21 and 28 days, the color doppler ultrasonography was used to examination vein blood flow and the DVT of affected lamb. In addition, the levels of D-dimer and bleeding were observed during treatment. Results The incidence o f DVT in observation group （2 cases, 2.23%） was significantly lower than that in control group （7 cases, 8.75%）, and DVT of control group was happened on 7th day after surgery. In addition, the level of D-dimer on 7th day post-surgery in observation group significantly decreased, while it significantly decreased on 14th day post-surgery in control group （P〈0.05）. However, the incidence of bleeding events in observation was less than that in control group （P〈0.05）. Conclusion Rivaroxaban can be more effective compared with warfarin in preventing diabetes mellitus elderly hip fracture patients with postoperative DVT formation and significantly reduce the bleeding risk, with more safe and convenient.