利伐沙班联合氯吡格雷治疗急性脑梗死合并下肢深静脉血栓形成的临床疗效

Clinical efficacy of rivaroxaban combined with clopidogrel in the treatment of acute cerebral infarction complicated with deep venous thrombosis of lower limbs

目的观察利伐沙班联合氯吡格雷治疗急性脑梗死合并下肢深静脉血栓形成的临床疗效。方法选取2020年6月—2021年6月长沙市中心医院收治的急性脑梗死合并下肢深静脉血栓形成患者88例,按照随机数字表法分为对照组与试验组,各44例。对照组予以氯吡格雷联合低分子肝素钙,试验组予以氯吡格雷联合利伐沙班。2组均连续治疗10 d。比较2组临床疗效,治疗前后血小板计数、血红蛋白、丙氨酸氨基转移酶、患侧下肢周径、双侧下肢周径差、凝血功能指标[D-二聚体、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)],药物不良反应。结果试验组患者治疗总有效率97.73%,高于对照组的81.82%(χ^(2)=4.456,P=0.035)。治疗后,2组患者血红蛋白、丙氨酸氨基转移酶比较,差异无统计学意义(P>0.05);治疗后,对照组患者血小板计数低于治疗前,但试验组血小板计数高于对照组(P<0.01)。治疗后,2组患者患侧下肢周径、双侧下肢周径差均减小,且试验组小于对照组(P<0.01)。治疗后2组D-二聚体、FIB较治疗前降低,且试验组低于对照组(P<0.01)。2组药物不良反应总发生率比较,差异无统计学意义(P>0.05)。结论利伐沙班联合氯吡格雷治疗急性脑梗死合并下肢深静脉血栓形成的临床疗效确切,可有效改善患肢肿痛症状和凝血功能,且安全性较高。

Objective To observe clinical efficacy of rivaroxaban combined with clopidogrel in the treatment of acute cerebral infarction complicated with deep venous thrombosis of lower limbs.Methods A total of 88 cases of patients with acute cerebral infarction complicated with deep venous thrombosis of lower limbs were selected from June 2020 to June 2021 in Changsha Central Hospital,which were divided into control group and experimental group according to the random number table method,with 44 cases in each group.The control group was given clopidogrel combined with low molecular weight heparin calcium,and the experimental group was given clopidogrel combined with rivaroxaban.Both groups were continuously treated for 10 days.Clinical efficacy,platelet count,hemoglobin,alanine aminotransferase,peripheral diameter of affected lower limbs,peripheral diameter difference of bilateral lower limbs,coagulation function indexes[D-dimer,fibrinogen(FIB),activated partial thromboplastin time(APTT)]before and after treatment,drug adverse reactions were compared between the two groups.Results The total effective rate in the experimental group was 97.73%,which was higher than 81.82%in the control group(χ^(2)=4.456,P=0.035).After treatment,there was no significant difference in hemoglobin and alanine aminotransferase between the two groups(P>0.05);after treatment,the platelet count in the control group was lower than that before treatment,and the platelet count in the experimental group was higher than that in the control group(P<0.01).After treatment,the peripheral diameter of the affected lower limbs and the peripheral diameter difference of the bilateral lower limbs in the two groups decreased,and the peripheral diameter difference of the affected lower limbs and the bilateral lower limbs in the experimental group were less than those in the control group(P<0.01).After treatment,the levels of D-dimer and FIB in the two groups were lower than those before treatment,and the levels of D-dimer and FIB in the experimental group were lower than those in the control group(P<0.01).There was no significant difference in the total incidence of drug adverse drug reactions between the two groups(P>0.05).Conclusion Rivaroxaban combined with clopidogrel have an exact clinical effect for acute cerebral infarction complicated with deep venous thrombosis of lower limbs,can effectively improve the symptoms of swelling and pain of affected limbs and coagulation function,and with high safety.