低分子肝素钙治疗老年创伤后急性深静脉血栓的临床应用

The clinical application of nadroparin calcium for treating cute traumatic deep vein thrombosis in elderly patients

目的分析低分子肝素钙和利伐沙班对老年创伤后急性深静脉血栓患者溶栓治疗的临床效果及安全性。方法前瞻性收集厦门大学附属福州第二医院2012年9月至2016年12月老年下肢骨折急性深静脉血栓形成患者76例,电脑随机数字法将其分配成低分子肝素钙组和利伐沙班组,每组患者38例,根据患者体重,低分子肝素钙组予以溶栓剂量q12 h皮下注射进行溶栓治疗,利伐沙班组给予溶栓剂量q12 h口服进行溶栓治疗,连续治疗1 w,比较两组患者的深静脉血栓变化情况及出血性事件发生率。结果低分子肝素钙组溶栓有效率为92.105%(35/38),利伐沙班组溶栓有效率为71.053%(27/38),低分子肝素钙组中溶栓有效率高于利伐沙班组,差异有统计学意义(X^2=4.354,P=0.037);低分子肝素钙和利伐沙班均可降低患者血浆D-dimer(F=10050.7,P<0.001)及FIB水平(F=413.24,P<0.001),低分子肝素钙组患者血浆D-dimer水平均显著低于利伐沙班组(F=53.21,P<0.001);两组均无严重出血事件,低分子肝素钙组出血发生率为15.789%(6/38),利伐沙班组出血发生率为20.053%(8/38),两组出血性事件发生率差异无统计学意义。结论对于创伤后急性深静脉血栓的老年患者,低分子肝素钙和利伐沙班均可进行有效的溶栓治疗,低分子肝素钙的溶栓疗效高于利伐沙班,在安全性方面,利伐沙班并无显著优势。低分子肝素钙治疗创伤后急性下肢静脉血栓疗效肯定,安全性高,值得临床推广。

Objective To analyze the clinical effect and safety of nadroparin calcium and rivaroxabanon thrombolytic therapy in elderly patients with acute deep venous thrombosis after trauma. MethodsA prospective study was conducted on 76 patients with acute deep vein thrombosis of lower extremity fracturein the Fuzhou Second Affiliated Hospital of Xiamen University from September 2012 to December2016. All patients were randomly divided into nodroparin calcium group and rivaroxaban group according tothe computer random number method, 38 patients in each group. According to the patient＇s body weight, nodroparincalcium group were given thrombolytic dose by subcutaneous injection of q12 h, rivaroxaban groupwith rivaroxaban thrombolytic dose of q12 h orally, both treatment last for 1 week, deep venous thrombuschanges and the incidence of hemorrhagic events were compared between two groups. Results The effectiverate of thrombolysis in nodroparin calcium group was 92.105% （35/38）, higher than rivaroxaban group71.053% （27/38）, difference was statistically significant （c2=4.354, P=0.037）. Both nodroparin calcium andrivaroxaban decreased the plasma levels of D-dimer （F=10050.7, P〈0.001） and FIB （F=413.24, P〈0.001）.The level of plasma D-dimer was significantly lower than that in the rivaroxaban group （F=53.21, P〈0.001）.No severe bleeding was observed in both groups, and the incidence of bleeding in nodroparin calcium groupwas 15.789% （6/38）, rivaroxaban group was 20.053% （8/38） with no statistically different. Conclusions For aged patients with acute deep venous thrombosis after trauma, both nodroparin calcium and rivaroxabancould be used for thrombolytic therapy with high effectiveness and better effect than rivaroxaban, while withno significant advantage on safety. Nodroparin calcium was safe and effective treatment for acute lower extremitytraumatic venous thrombosis, it worth clinical promotion.