氨甲环酸抗纤溶后利伐沙班应用于全髋关节置换术的研究

Analysis of the application of Rivaroxaban after anti-fibrinolysis with Tranexamic acid in total hip arthroplasty

目的评价接受全髋关节置换术(THA)患者在氨甲环酸抗纤溶后应用利伐沙班预防静脉血栓栓塞症(VTE)的安全性和有效性。方法选取2015年3月~2016年9月因股骨头坏死在河南省洛阳正骨医院接受THA的60例患者,采取随机数字表法分为A组(低分子肝素钙组)与B组(利伐沙班组),每组各30例。两组患者均在术前静脉滴注和术后腔内注射氨甲环酸。比较两组患者失血量、VTE发生率、输血率、抗凝相关出血事件的发生率和凝血功能。结果两组患者在失血量、输血率方面的比较,差异无统计学意义(P>0.05)。两组在随访期间均未出现症状性肺栓塞、深静脉血栓形成,两组VTE发生率比较,差异无统计学意义(P>0.05)。抗凝相关出血事件中,两组患者均未出现大出血事件,两组非大出血事件比较,差异无统计学意义(P>0.05)。术后凝血功能检测显示,两组患者凝血酶原时间、活化部分凝血活酶时间与术前相比均在安全范围内有延长,同一时间点组间比较差异无统计学意义(P>0.05)。结论 THA患者在氨甲环酸抗纤溶后应用低分子肝素钙或利伐沙班预防VTE均是安全而有效的。但低分子肝素钙需要皮下注射、调整剂量;相比而言,利伐沙班的患者接受度和依从性更高,从而保证患者术后药物预防VTE时间,提高手术安全性。

Objective To evaluate the safety and efficacy of Rivaroxaban anticoagulation in the prevention of venous thromboembolism （VTE） after Tranexamic anti-fibrinolysis in total hip arthroplasty （THA） patients. Methods From March 2015 to September 2016, sixty patients with osteonecrosis of femoral head accepted THA in Henan Luoyang Orthopedic Traumatological Hospital were divided into two groups by random number table, with 30 cases in each group. The patients in group A were treated with low molecular weight heparin calcium to prevent VTE, while the patients in group B were treated with Rivaroxaban. In both groups, preoperative intravenous injection and postoperative intracavi- tary injection of Tranexamic acid were performed. The blood loss volume, the occurrence rates of VTE, blood transfu-sion and anticoagulation-related bleeding events, and blood coagulation between the two groups were recorded and compared. Results There was no significant difference in blood loss volume and transfusion rate between the two groups （P 〉 0.05）. During the follow-up, it had no symptomatic pulmonary embolism and deep venous thrombosis in the both groups, and there was no significant difference in the rate of VTE between the two groups （P 〉 0.05）. As for anticoagulant bleeding events, major bleeding events were not found in the two groups, and there was no significant difference in non-major bleeding events （P 〉 0.05）. Postoperative coagulation test showed that the prothrombin time and activated partial thromboplastin time in both groups were longer in the safety range than in the preoperative period, and there was no statistically significant difference between groups at the same time （P 〉 0.05）. Conclusion The use of low molecular weight heparin calcium or rivaroxaban in the prevention of venous thromhoembolism in patients with THA are both safe and effective. However low molecular weight heparin calcium requires subcutaneous injection and close adjustment. In contrast,patients in Rivaroxaban are more receptive and compliant, which can be ensured that the postoperative drug prevention VTE time and improve surgical safety.