低分子量肝素与口服抗凝剂预防脊柱创伤后下肢深静脉血栓形成和肺栓塞研究

Study of the Effect of Low Molecular Weiqht Heparin and Oral Anticoaqulant in Prevention Deep Venous Thrombosis and Pulmonary Embolism After Spinal Jnjury

目的:本研究旨在比较直接口服抗凝剂(DOACs)和低分子肝素(LMWH)对手术性脊柱损伤患者预后的影响。方法:本研究纳入2015年至2020年在我院治疗的脊柱创伤手术患者共760例,根据患者治疗情况分为DOACs组和LMWH组,比较两组深静脉血栓(DVT)、肺栓塞(PE)、红细胞输注率(PRBC)和脊髓减压手术的干预率和死亡率。结果:经过筛选760例患者被纳入此研究,其中使用LWMH预防术后血栓的患者415例,使用DOACs预防术后血栓的患者345例,患者平均年龄(61.73±15)岁,59%为男性,受伤程度中位数为12(10~18),两组在人口统计学、生命体征、损伤参数、住院时间、下腔静脉滤网放置率和血栓预防开始时间等方面无差异。院内DVT发生率为5.4%,院内PE发生率为1.3%,住院病死率为2.8%。接受DOACs进行血栓预防的患者的深静脉血栓发生率低于接受LMWH治疗的患者(1.2%vs 8.9%,P<0.001),两组肺栓塞发生率差异无统计学意义(0.3%vs 2.1%,P=0.24)。住院病死率、术后pRBC输血率和脊髓术后减压的总发生率无差异。结论:在脊柱创伤手术患者中,DOAC可以有效降低DVT和PE的发生率。

Objective:Patients with spinal trauma are at high risk of venous thromboembolism(VTE).To compare the effects of direct oral anticoagulants(DOACs)and low molecular weight heparin(LMWH)on the outcome of patients with surgical spinal injury.Methods:A total of 760 spinal trauma surgery patients treated in our hospital from 2015 to 2020 were included.According to the treatment conditions of patients,they were divided into DOACs group and LMWH group,and the intervention rate and mortality of deep venous thrombosis(DVT),pulmonary embolism(PE),red blood cell infusion rate(PRBC)and spinal decompression surgery were compared between the two groups.Results:A total of 760 patients were included,including 415 patients who received LWMH for postoperative thrombosis prevention and 345 patients who received DOACs for postoperative thrombosis prevention.The mean age of patients was(61.73±15)years,59%were male,and the median injury level was 12(10~18).There were no differences between the two groups in demography,vital signs,injury parameters,length of hospital stay,ivC filter placement rate and time to start thrombus prophylaxis.The incidence of hospital DVT was 5.4%,the incidence of hospital PE was 1.3%,and the mortality was 2.8%.DOACs had a lower incidence of DVT(1.2%vs 8.9%,P<0.002)and pulmonary PE(0.3%vs 2.1%,P=0.24).There were no differences in mortality,postoperative pRBC transfusion rate,or overall incidence of postoperative spinal decompression.Conclusion:DOAC can effectively reduce the incidence of DVT and PE in patients with spinal trauma surgery.This study provides a solid basis for future studies.