腰椎手术患者术后应用利伐沙班和低分子肝素对凝血功能变化和深静脉血栓的预防作用对比

A comparative study on application of rivaroxaban or low molecular weight heparin on blood coagulation and its effect for prevention of venous thromboembolism after lumbar spine surgery

目的对比腰椎手术患者术后应用利伐沙班和低分子肝素对凝血功能变化和深静脉血栓的预防作用。方法前瞻性选取130例老年腰椎疾病患者被随机分为对照组(n=65)和治疗组(n=65),对照组术后给予低分子肝素,治疗组术后给予利伐沙班。比较两组用药前后凝血凝血酶原时间(PT)、部分凝血活酶时间(APTT)、血小板计数、术后创口引流量以及下肢静脉血栓发生率和出血性并发症发生情况。结果与术前相比,术后两组患者PT和APTT均显著延长(P<0.05),两组间术后PT和APTT比较差异无统计学意义(P>0.05);与术前相比,两组术后血小板计数均有所升高(P<0.05),术后14天呈下降趋势(P<0.05),但两组间比较差异无统计学意义(P>0.05);治疗组术后创口引流量显著低于对照组(P<0.05);治疗组下肢静脉血栓和出血性并发症发生率均明显低于对照组(P<0.05)。结论利伐沙班可有效预防腰椎骨折术后深静脉血栓的发生,较低分子肝素更安全。

Objective To compare the application of rivaroxaban or low molecular weight heparin on blood coagulation and its effect for prevention of venous thromboembolism after lumbar spine surgery.Methods A total of 130 patients with lumbar spine surgery were randomly divided into control group(n = 65) and trial group(n = 65) for this prospective study.Patients in control group were given with low molecular weight heparin,while patients in trial group were given with rivaroxaban.The clotting prothrombin time(PT),activated partial thromboplastin time(APTT),platelet count,amount of postoperative wound drainage and the incidence of lower limb venous thrombosis and complications of hemorrhage occurred were examined and compared between these 2 groups.Results In comparison with those before treatment,PT and APTT were significantly increased(P < 0.05),but the difference between these two groups was not remarkable(P > 0.05).The blood platelet count had been increased than that before treatment(P < 0.05),but the difference between these two groups was not remarkable(P > 0.05).The incidence rates of DVT and hemorrhagic complications in trial group were significantly reduced(P < 0.05).Conclusion The rivaroxaban is an effective and safe agent for prevention of the occurrence of deep venous thrombosis(DVT) after lumbar spine surgery.