利伐沙班与华法林治疗骨科创伤后下肢静脉血栓形成患者的疗效比较研究

Comparative effectiveness research of rivaroxaban and warfarin on treating patients with lower limb venous thrombosis after orthopedic trauma

目的比较利伐沙班与华法林治疗骨科创伤后下肢静脉血栓形成患者的疗效。方法选取2018年10月—2020年9月分宜县人民医院收治的骨科创伤后下肢静脉血栓形成患者86例,根据入院先后顺序分为对照组43例和观察组43例。对照组予以华法林治疗,观察组予以利伐沙班治疗,2组均持续用药10 d。比较2组下肢静脉栓子检出率,用药前、用药后5 d、用药后10 d血液流变学(全血高切黏度、全血低切黏度、血液黏度及红细胞聚集指数)、凝血功能指标[凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)]和不良反应。结果观察组下肢静脉栓子检出率为2.33%,低于对照组的18.60%(χ^(2)=4.468,P=0.035)。用药后5、10 d,观察组全血高切黏度、红细胞聚集指数高于对照组,血液黏度低于对照组(P<0.05)。用药后5、10 d,2组TT、PT、APTT、FIB比较,差异无统计学意义(P>0.05)。观察组用药后5、10 d D-D高于对照组(P<0.05)。2组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论与华法林相比,利伐沙班可有效改善骨科创伤后下肢静脉血栓形成患者的血液流变学,进而改善机体凝血功能,减少下肢静脉栓子形成。

Objective To compare the effect of rivaroxaban and warfarin on treating patients with lower limb venous thrombosis after orthopedic trauma.Methods From October 2018 to September 2020,86 cases of patients with lower limb venous thrombosis after orthopedic trauma were selected,and they were divided into control group and observation group according to the order of admission,with 43 cases in each group.Patients in control group were treated with warfarin,patients in observation group were treated with rivaroxaban,both groups were treated for 10 days.Detection rate of venous embolus in lower limbs,hemorheology indexes(whole blood high shear viscosity,whole blood low shear viscosity,blood viscosity and erythrocyte aggregation index),coagulation function indexes(TT,PT,APTT,FIB,D-D)before medication and at 5,10 days after medication,incidence of adverse reactions were compared between the two groups.Results Detection rate of venous embolus in lower limbs in observation group was 2.33%,which was lower than 18.60%of control group(χ^(2)=4.468,P=0.035).At 5,10 days after medication,whole blood high shear viscosity,erythrocyte aggregation index in observation group were higher than those in control group,blood viscosity was lower than that in control group(P<0.05).There was no significant difference in TT,PT,APTT and FIB between the two groups on the 5th and 10th day after treatment(P>0.05).At 5,10 days after medication,D-D in observation group was higher than that in control group(P<0.05).There was no significant difference in incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with warfarin,rivaroxaban can effectively improve hemorheology of patients with lower limb venous thrombosis after orthopedic trauma,thereby improving the coagulation function of the body,and reduce the formation of venous thrombosis of lower limbs.