利伐沙班和低分子肝素钙预防中重度脑出血术后下肢深静脉血栓形成的效果比较

Comparison of the Effects of Rivaroxaban and Low-molecular-weight Heparin Calcium in Preventing Deep Vein Thrombosis of Lower Extremities After Moderate to Severe Intracerebral Hemorrhage

目的比较利伐沙班和低分子肝素钙预防中重度脑出血后下肢深静脉血栓(DVT)形成的有效性及安全性。方法选择佳木斯市中医院2019年1月~12月收治的中重度ICH术后患者83例,采取随机数字表法分为利伐沙班组(n=42)和低分子肝素钙组(n=41)。利伐沙班组采用利伐沙班治疗,低分子肝素钙组采用低分子肝素钙治疗。比较两组患者DVT发生率、凝血功能指标[血小板计数(PLT)、纤维蛋白原(Fib)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、D-二聚体(D-D)]、不良反应发生情况。结果利伐沙班组DVT发生率为4.76%,低分子肝素钙组DVT发生率为7.31%,两组患者DVT发生率比较,差异无统计学意义(P>0.05);两组患者PT、APTT均升高,PLT、Fib、D-D均降低,差异有统计学意义(P<0.05);利伐沙班组PT、APTT高于低分子肝素钙组,PLT、Fib、D-D低于低分子肝素钙组,差异有统计学意义(P<0.05);两组患者均未出现牙龈出血、皮下瘀斑、黑便、血尿、眼底出血、鼻衄、颅内再出血等不良反应。结论利伐沙班和低分子肝素钙预防中重度ICH术后DVT的有效性和安全性均较好,且利伐沙班改善凝血功能效果更佳。

Objective To compare the effectiveness and safety of rivaroxaban and low-molecular-weight heparin calcium in preventing the formation of deep vein thrombosis(DVT)of the lower extremities after moderate to severe intracerebral hemorrhage.Methods A total of 83 patients with moderate to severe ICH who were admitted to Jiamusi Traditional Chinese Medicine Hospital from January to December 2019 were selected.A random number table was used to divide them into the rivaroxaban group(n=42)and the low-molecular-weight heparin calcium group(n=41).The rivaroxaban group was treated with rivaroxaban,and the low-molecular-weight heparin calcium group was treated with low-molecular-weight heparin calcium.The incidence of DVT and coagulation function indexes[platelet count(PLT),fibrinogen(Fib),prothrombin time(PT),partial thromboplastin time(APTT),and D-dimer(D-D)were compared between the two groups of patients],the occurrence of adverse reactions.Results The incidence of DVT in the rivaroxaban group was 4.76%,and the incidence of DVT in the low molecular weight heparin calcium group was 7.31%.There was no significant difference in the incidence of DVT between the two groups(P>0.05);The PT and APTT of the two groups were all increased,while PLT,Fib,and D-D were all decreased,the difference was statistically significant(P<0.05);The PT and APTT of the rivaroxaban group were higher than the low-molecular-weight heparin calcium group,and the PLT,Fib,and D-D were lower than the low-molecular-weight heparin calcium group,the difference was statistically significant(P<0.05);There were no adverse reactions such as gum bleeding,subcutaneous ecchymosis,melena,hematuria,fundus bleeding,epistaxis,intracranial hemorrhage,etc.in both groups.Conclusion Rivaroxaban and low-molecular-weight heparin calcium are effective and safe in preventing moderate to severe ICH postoperative DVT,and rivaroxaban is more effective in improving coagulation function.