小剂量利伐沙班联合阿司匹林在急性期髋部骨折围手术期抗凝的疗效研究

Study on the curative effect of low-dose rivaroxaban combined with aspirin in perioperative anticoagulation of acute hip fracture

目的探讨小剂量利伐沙班联合阿司匹林对急性期髋部骨折围手术期抗凝效果以及对深静脉血栓的预防效果。方法采取前瞻性研究,于2018年1月-2019年11月入西安市中心医院接受急性期髋部骨折围手术患者95例,随机分为两组,研究组43例,给予小剂量利伐沙班联合阿司匹林;对照组42例,给予阿司匹林。对双侧下肢深静脉血栓(deep vein thrombosis,DVT)的发生情况进行观察;检测两组不同给药方式前后的血红蛋白(hemoglobin,Hb)、血小板计数(platelet coount,PLT)以及凝血指标,包括凝血酶原时间(prothrombin time,PT)、部分活化凝血酶原时间(activited partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)、全血黏度和血浆黏度比较,评价预防抗凝期间的出凝血情况,并记录严重出血、肺栓塞等不良事件的发生情况。结果治疗总有效率研究组为90.70%,高于对照组的71.43%(P<0.05);治疗前后两组的凝血指标、Hb水平、血液黏度和血小板计数水平均有所改善(P<0.05);术后研究组患者的DVT发生率6.98%低于对照组的23.81%(P<0.05);术后研究组患者的抗凝效果97.67%高于对照组的78.57%(P<0.05)。结论急性期髋部骨折围手术患者采用小剂量利伐沙班联合阿司匹林能够有效提高抗凝效果,降低术后DVT发生率,且对患者凝血功能、血小板无明显影响,不会增加出血风险,安全性性高。

Objective To investigate the anticoagulant effect of low-dose rivaroxaban combined with aspirin on the perioperative period of acute hip fracture and the preventive effect of deep vein thrombosis.Methods A prospective study was adopted.From January 2018 to November 2019,95 patients with acute hip fracture were admitted to Xi′an Central Hospital for perioperative hip fracture.They were randomly divided into two groups,43 cases in the study group were given low-dose rivaroxa Combine aspirin with ban;42 cases in the control group were given aspirin.Observe the occurrence of deep vein thrombosis(DVT)in both lower extremities;detect hemoglobin(hemoglo-bin,Hb),platelet coount(PLT)and coagulation indicators before and after different administration methods in the two groups.Including prothrombin time(prothrombin time,PT),partial activation Comparison of activated partial thromboplastin time(APTT),fibrinogen(FIB),whole blood viscosity,and plasma viscosity to evaluate the prevention of coagulation during anticoagulation period,and record serious bleeding,pulmonary embolism and other adverse effects How the incident occurred.Results The total effective rate of treatment in the study group was 90.70%,which was higher than 71.43%in the control group(P<0.05);the coagulation index,Hb level,blood viscosity and platelet count level of the two groups were improved before and after treatment(P<0.05)The incidence of DVT in the postoperative study group was 6.98%lower than that of the control group 23.81%(P<0.05);the postoperative anticoagulant effect of the study group was 97.67%higher than that of the control group 78.57%(P<0.05).Conclusion The use of low-dose rivaroxaban combined with aspirin for acute hip fracture perioperative patients can effectively improve the anticoagulant effect,reduce the incidence of postoperative DVT,and has no significant effect on the patient′s coagulation function and platelets,and does not increase the risk of bleeding.It is safe High sex.