小剂量利伐沙班联合阿司匹林在预防脊柱脊髓损伤患者术后下肢深静脉血栓中的应用

Application of the combination of small doses of rivaroxaban and aspirin in the prevention of postoperative deep venous thrombosis in patients with spinal cord injury

目的探讨小剂量利伐沙班联合小剂量阿司匹林在预防脊柱脊髓损伤患者术后下肢深静脉血栓方面的有效性以及其出血风险。方法选取2016年5月~2018年7月因脊柱脊髓损伤在湛江中心人民医院脊柱外科接受手术治疗的患者138例,按随机数字表法分为A、B、C三组:A组42例,术后第1天起予利伐沙班每日10 mg;B组50例,术后第1天起予阿司匹林每日100 mg;C组4例,在术后第1天开始早饭后口服阿司匹林25 mg/d的同时口服利伐沙班10 mg/d,4 d后利伐沙班剂量改为5 mg/d,7 d后改为2.5 mg/d并长期维持治疗。通过下肢静脉彩超检查了解术后2周、随访1个月、3个月、6个月及12个月的下肢静脉血栓发生情况;随访记录病例在用药后出现的术部切口出血及其他部位出血情况。对记录数据进行统计分析。结果疗效方面,C组与A、B两组在脊柱脊髓损伤患者术后预防下肢深静脉血栓方面疗效差异无统计学意义。而安全性方面,B组术后6个月及12个月的出血事件发生率分别为C组的7倍与8.8倍,差异有统计学意义(P<0.05);随访12个月结果显示A组出血事件发生率为C组的6倍,差异有统计学意义(P<0.05)。结论小剂量利伐沙班联合小剂量阿司匹林是预防脊柱脊髓损伤患者术后下肢深静脉血栓形成的有效治疗方案,且其出血风险更低。

Objective To study the effect and risk of bleeding of the combination of small doses of rivaroxaban and aspirin on the prevention of postoperative deep venous thrombosis(DVT)in patients with spinal cord injury.Methods The clinical data of 138 patients undergoing surgery after spinal cord injury from May 2016 to July 2018 were retrospective analyzed.The patients were randomly divided into three groups.Forty-two patients in group A were treated with rivaroxaban 10 mg per day from the 1 st day after surgery.Fifty patients in group B were treated with aspirin 100 mg per day from the 1 st day after surgery.Forty-six patients in group C were treated with rivaroxaban 10 mg and aspirin 25 mg per day from the 1 st day after surgery,4 days later,the treatment changed into rivaroxaban 5 mg and aspirin 25 mg per day,at 7 d after operation,the treatment changed into rivaroxaban 2.5 mg and aspirin 25 mg per day.The vessels of lower extremity were detected by_Doppler ultrasonography at 2 and 4 weeks,and 3,6 and 12 months after operation.The bleeding in incision and any other part of the body was recorded.The rate of DVT and bleeding was analyzed.Results There was no statistically significant difference in efficacy among three groups.The incidence rate of bleeding events of group B was respectively 7 times and 8.8 times as much as group C at 6 and 12 months after surgery,with statistically significant differences(P<0.05).The incidence rate of bleeding events of group A was 6 times as much as group C at 12 months after surgery,with statistically significant difference(P<0.05).Conclusions The combination of small doses of rivaroxaban and aspirin can effectively prevent the formation of postoperative DVT in patients with spinal cord injury,and it has lower risk of bleeding.