利伐沙班对老年重度腰椎管狭窄患者围手术期的影响及安全性研究

Effects of rivaroxaban on perioperative period status and its safety in elderly patients with severe lumbar spinal stenosis

目的探究利伐沙班及低分子肝素对老年腰椎管狭窄需卧床制动患者应用后围手术期出血事件、凝血功能及深静脉血栓(deep venous thrombosis,DVT)形成的影响。方法选取2017年5月至2018年5月60周岁以上腰椎管狭窄术前需卧床制动患者79例,口服利伐沙班患者37例,患者入院后给予利伐沙班口服,1次/d,术日停服1 d;皮下注射低分子肝素患者42例,患者入院后给予低分子肝素皮下注射,1次/d,术前12 h停止用药1次,术后第1天继续用药;比较2组围手术期显性及隐性失血量、围手术期出血事件发生例数、凝血功能变化及术后DVT例数。结果利伐沙班组及低分子肝素组围手术期显性出血量、出血时间发生率、凝血功能变化及术后DVT发生率差异无统计学意义(P>0.05),但利伐沙班组隐性失血量少于低分子肝素组,差异有统计学意义(P<0.05)。结论利伐沙班与低分子肝素对腰椎管狭窄卧床患者抗凝效果一致,但利伐沙班可减少术中隐性失血量。

Objective To investigate the effects of rivaroxaban and low molecular weight heparin on the perioperative bleeding events and deep venous thrombosis(DVT)in elderly patients with lumbar spinal stenosis requiring bed rest.Methods A total of 79 elderly patients(over 60 years of age)with lumbar spinal stenosis who required bed rest before operation in our hospital from May 2017 to May 2018 were enrolled in the study,who were divided into rivaroxaban group(n=37),in which,the patients were treated by oral rivaroxaban,once a day,and stopping medication at the day of surgery,moreover,the other 42 patients were enrolled as low molecular weight heparin group,in which,the patients were given low molecular weight heparin by subcutaneous injection,once a day,and stopping medication at 12 hours before surgery.The numbers of patients with perioperative dominant and recessive blood loss,and the cases with perioperative bleeding events,and blood coagulation function as well as the incidence of postoperative DVT were observed and compared between the two groups.Results There were no significant differences in the perioperative significant bleeding volume,bleeding time and the incidence of postoperative DVT between the two groups(P>0.05),however,the recessive blood loss in rivaroxaban group was significantly less than that in low molecular weight heparin group(P<0.05).Conclusion Rivaroxaban has the same anticoagulant effects as those by low molecular weight heparin,however,rivaroxaban can reduce the amount of invisible blood loss during surgery.