血栓弹力图评估接受利伐沙班抗凝的髋关节翻修患者围术期凝血变化

Thrombelastogram for evaluating perioperative blood clot changes in patients received rivaroxaban anticoagulation after hip revision surgery

目的:使用血栓弹力图(thrombelastography,TEG)评估髋关节翻修术术后接受利伐沙班抗凝的患者凝血功能变化。方法:回顾2014年4月至2017年12月75例髋关节翻修的患者资料。所有患者术后12 h内开始服用利伐沙班10 mg预防血栓,频率为每日一次。所有患者在术前和术后第1、3、5、7天进行TEG测定。比较患者TEG参数的变化及不同时间点高凝状态的比例差异。结果:术后第1、3、5、7天的平均凝血反应时间(reaction time,R)较术前降低,且具有统计学差异。术后第1、3、5、7天的平均凝血指数(clot index,CI)较术前升高,具有统计学意义。术后第5、7天的平均最大振幅(maximum amplitude,MA)较术前升高,且具有统计学意义。术后第7天有34.67%的患者呈高凝状态,且以混合性高凝为主。结论:髋关节翻修术后使用常规剂量利伐沙班抗凝,患者仍处于血液高凝状态,且血液高凝以混合性高凝为主。现有的髋关节翻修术后血栓预防方案可能存在不足,探究个体化的抗凝方案是未来髋关节翻修术后血栓预防的研究方向。

Objective:To assess the coagulation function changes by using thrombelastogram(TEG) in patients receiving rivaroxaban anticoagulation after hip revision surgery. Methods:Data of 75 patients underwent hip revision from April 2014 to December 2017 were reviewed. All patients took rivaroxaban of 10 mg within 12 hours after surgery to prevent thrombus with the frequency of once a day. All patients received TEG determination before surgery and on the 1 st,3 nd,5 th and 7 th day after surgery. Changes of TEG parameters and proportional difference of hypercoagulable states at different time were compared. Results:Reaction time(R) on the 1 st,3 nd,5 th and 7 th day after surgery was decreased than that before surgery,with statistically significant difference. Mean clot index(CI) on the 1 st,3 nd,5 th and 7 th day after surgery was increased than that before surgery,with statistically significant difference. Mean maximum amplitude(MA) on the 5 th and 7 th day after surgery was increased than that before surgery,with statistically significant difference. A total of 34.67% patients had hypercoagulable states on the 7 th day,with the main of mixed hypercoagulability. Conclusion:The conventional dose of rivaroxaban is used for anticoagulation after hip revision,but the patient is still in a hypercoagulable state,with the main of mixed hypercoagulability. The existing thromboprophylaxis program after hip revision may be not perfect,therefore,exploring the individualized anticoagulation program is the future research direction.