利伐沙班与维生素K拮抗剂预防骨科创伤后下肢静脉血栓的临床效果分析

Clinical effect analysis of rivaroxaban and vitamin K antagonist in preventing venous thrombosis of lower limbs after orthopedic trauma

目的探讨利伐沙班与维生素K拮抗剂预防骨科创伤后下肢静脉血栓形成的临床效果。方法 选择150例骨科创伤患者,随机分为利伐沙班组、华法林组及对照组,各50例,利伐沙班组与华法林组在骨折术后6 d开始使用利伐沙班或华法林预防性抗凝,对照组无预防性抗凝治疗。分别在干预前、干预5 d、干预10 d测定患者的血液流变学指标、凝血功能指标、D-二聚体(D-D)水平,观察下肢静脉血栓形成情况和出血并发症。结果 干预后,利伐沙班组、华法林组全血黏度高切和红细胞聚集指数的升高明显低于对照组(P<0.05)。3组的凝血功能指标及D-D水平均随时间延长而出现不同程度的升高,利伐沙班组仅D-D水平升高明显低于华法林组(P<0.05),其它指标与华法林组比较无统计学意义(P>0.05),2组均明显低于对照组(P<0.05)。利伐沙班组和华法林组静脉栓子检出率明显低于对照组(P<0.05)。结论 利伐沙班与华法林的效果相似,但利伐沙班用药方便,无需监测INR,可作为优选。

Objective To investigate the clinical effect of rivaroxaban and vitamin K antagonist in preventing venous thrombosis of lower limbs after orthopedic trauma.Methods 150 cases of orthopedic trauma patients were selected from May 2017 to May 2019 in our hospital and randomly divided into rivaroxaban group,warfarin group and control group,50 cases in each group.The rivaroxaban group and warfarin group began to use rivaroxaban or warfarin prophylactic anticoagulation 6 days after the fracture surgery,while the control group had no prophylactic anticoagulation treatment.Hemorheology indexes,coagulation function indexes and D-dimer (D-D) levels of the patients were measured before intervention,5 d and 10 d after intervention respectively,and venous thrombosis of lower limbs and bleeding complications were observed.Results After intervention,the increase of the whole blood viscosity and the aggregation index of red blood cells were significantly lower than that in the control group (P<0.05).The coagulation function indexes and D-D levels of the three groups increased with time to varying degrees.Only the increase in D-D level of the rivaroxaban group was significantly lower than that of the warfarin group (P<0.05),and the other indexes were not statistically significant (P>0.05),while all the indexes in the two treatment groups were significantly lower than those in the control group (P<0.05).The detection rate of vein emboli in the two treatment groups was significantly lower (P<0.05).Conclusion Preventive anticoagulation in orthopedic trauma patients has a clinical significance.Rivaroxaban and warfarin have similar effect,but rivaroxaban is convenient to use and does not need to monitor INR,thus can be used as the optimal choice.