利伐沙班的药学机制、临床应用及安全用药影响因素

Pharmaceutical Mechanism,Clinical Application and Influencing Factors of Safe Medication of Rivaroxaban

骨科大手术后下肢深静脉血栓(Deep venous thrombosis,DVT)是常见的术后严重并发症,也是导致患者围手术期死亡的重要原因之一。由于骨科大手术可激活内源性凝血系统、损伤血管内皮,同时术后制动、卧床也明显增加了患者血栓形成的风险。血栓形成后,血栓栓子脱落并随下肢静脉血流回流到右心房、右心室、肺动脉进而造成肺动脉栓塞(Pulmonary embolism,PE),严重者造成患者死亡。因此,骨科大手术后预防DVT形成是提高手术疗效,降低并发症和患者围手术期死亡风险的重要措施。利伐沙班是一种口服的凝血因子Ⅹa抑制剂,用于DVT和肺栓塞的初始治疗,以及预防复发性DVT和PE,其以固定的口服剂量给药,不需要常规凝血监测,安全性较高。本文对近年来采用利伐沙班防骨科大手术后下肢深静脉血栓的相关研究进行综述,以期为临床治疗提供参考。

Deep venous thrombosis(DVT) of lower extremity after major orthopedic surgery is a common serious postoperative complication and one of the important causes of perioperative death. Because major orthopedic surgery can activate the endogenous coagulation system and damage the vascular endothelium, postoperative immobilization and bed rest also significantly increase the risk of thrombosis in patients. After thrombus formation, the thrombus emboli fall off and return to the right atrium, right ventricle and pulmonary artery with the venous blood flow of the lower extremities, resulting in pulmonary embolism(PE), which in severe cases causes death. Therefore, the prevention of DVT after major orthopedic surgery is an important measure to improve surgical outcomes, reduce complications and the risk of perioperative death. Rivaroxaban is an oral factor Xa inhibitor for the initial treatment of DVT and pulmonary embolism, as well as for the prevention of recurrent DVT and PE. It is administered at a fixed oral dose, does not require routine coagulation monitoring, and is safe. This article reviews the recent studies on rivaroxaban against lower extremity deep venous thrombosis after major orthopedic surgery, in order to provide reference for clinical treatment.