利伐沙班在重型颅脑损伤术后深静脉血栓防治中的效果分析

Clinical efficacy of rivaroxaban in prevention and treatment of postoperative deep vein thrombosisfor severe traumatic brain injury

目的探讨利伐沙班对重型颅脑损伤（sTBI）术后深静脉血栓（DVT）预防和治疗的临床效果。方法收集符合入组标准的sTBI患者157例，其中男119例（75.8%），年龄（38.75±11.98）岁。所有患者均应用间歇性静脉充气加压预防DVT，应用D－二聚体动态监测和定期超声检查对DVT进行筛查，如颅内出血情况稳定，对手术3 d后D－二聚体持续下降且存在高危因素者预防性口服利伐沙班，对确诊DVT患者治疗性口服利伐沙班，符合停药条件后停用利伐沙班。对患者的一般资料，D－二聚体动态变化，DVT发病情况，利伐沙班应用情况及抗凝出血并发症等进行回顾性分析。结果D－二聚体持续下降者超声均未发现DVT，D－二聚体持续不降或升高45例，超声发现DVT 43例。预防性应用利伐沙班47例（29.9%），用药7～36（16.3±6.5）d，随访期间均未见DVT发生；治疗性用药43例（27.4%），用药时程32～68（49.3±9.9）d，停药后仅1例复发周围型DVT。未见症状性肺栓塞及致死性出血并发症，发生血尿3例，气管切开处渗血1例，痔疮导致血便1例，未见颅内出血增加及其他消化道出血。结论应用利伐沙班抗凝可安全有效预防和治疗sTBI术后DVT。

ObjectiveTo explore the clinical efficacy of rivaroxaban in the prevention and treatment of postoperative deep vein thrombosis （DVT） for severe traumatic brain injury （sTBI）.MethodsPatients with sTBI who met the inclusion criteria were enrolled in this study, including 119 males （75.8%） and 38 females （24.2%）, aged （38.75 ± 11.98） years old. DVT was prevented and treated according to the DVT screening and anticoagulation regimen. Intermittent venous compression was used on all of the patients to prevent DVT, and D-dimer dynamic monitoring and regular ultrasound were performed to screen for DVT. For patients with stable intracranial hemorrhage, rivaroxaban was used when the D-dimer was declining continuously and high risks exist at the same time, or the DVT was diagnosed. Drug withdrawal was performed according to the regimen. The clinical information, D-dimer dynamic changes, rivaroxaban application, DVT, and bleeding complications were analyzed retrospectively.ResultsNone of the patients with continuously declining D-dimer was diagnosed with DVT according to the ultrasound examination. Of the 45 patients without progressively declining D-dimer, 43 cases were diagnosed with DVT. Rivaroxaban was used in 47 cases （29.9%） to prevent DVT and 43 cases （27.4%） to treat DVT, and the medication time was （16.3±6.5） and （49.3 ± 9.9） days, respectively. None was diagnosed with DVT after prophylactic administration, and 1 case relapsed after therapeutic administration. During the 6-months follow-up after injury, hematuria occurred in 3 cases, tracheotomy errhysis in 1 case and hemorrhoids bleeding in 1 case. Symptomatic pulmonary embolism, intracranial hemorrhage and fatal bleeding did not occur in any of the cases.ConclusionsThe application of rivaroxaban is safe and effective in preventing and treating the postoperative DVT.