阿哌沙班与低分子肝素预防髋/膝关节置换术后下肢深静脉血栓形成的临床效果比较

Comparison of clinical effects between apixaban and low molecular weight heparin in the prevention of lower limb deep vein thrombosis after hip/knee replacement

目的 比较阿哌沙班与低分子肝素预防髋/膝关节置换术后下肢深静脉血栓形成的临床效果。方法 回顾性分析2018年1月—2020年12月江苏省常州市第三人民医院收治的50例髋/膝关节置换术后患者临床资料,按用药方案不同分为观察组和对照组,各25例。术后对照组接受低分子肝素抗凝方案治疗,观察组接受阿哌沙班抗凝方案治疗,2组均持续用药2周。比较2组下肢静脉血栓发生率,治疗前后凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)]、血液流变学指标[血小板聚集率(PAR)、全血低切黏度、全血高切黏度]、生活质量评分(SF-36)变化及不良反应发生情况。结果 观察组与对照组的下肢静脉血栓发生率(4.00%vs. 8.00%)比较差异无统计学意义(χ^(2)=0.355,P=0.552);治疗2周后,2组PT、APTT与Fib水平较治疗前均无明显波动,差异无统计学意义(P均>0.05);2组PAR、全血低切黏度、全血高切黏度均较治疗前下降,SF-36各项评分均较治疗前升高,且观察组下降或升高的程度大于对照组(P均<0.01);观察组与对照组不良反应总发生率(8.00%vs. 12.00%)比较差异无统计学意义(χ^(2)=0.222,P=0.637)。结论 阿哌沙班与低分子肝素预防髋、膝关节置换术后下肢深静脉血栓形成的临床效果及对凝血功能的影响相当,但在患者血液流变学指标与SF-36评分方面改善明显,值得临床推广应用。

Objective To compare the clinical effects of apixaban and low molecular weight heparin in the prevention of lower limb deep vein thrombosis after hip/knee replacement. Methods Retrospective analysis of the clinical data of 50 patients after hip/knee replacement admitted to Changzhou Third People′s Hospital from January 2018 to December 2020. The patients were divided into the observation group and the control group according to the different medication schemes, with 25 patients in each group. After operation, the control group received anticoagulation regimen of low molecular weight heparin, and the observation group received anticoagulation regimen of apixaban. Both groups continued to use the drug for 2 weeks. The incidence of lower limb venous thrombosis, changes of coagulation function indexes(PT, APTT, Fib), hemorheology indexes(PAR, whole blood low shear viscosity, whole blood high shear viscosity), and quality of life scores(SF-36) before and after treatment were compared between the two groups. And the occurrence of adverse reactions in two groups. Results There was no significant difference between the observation group and the control group in the incidence of lower limb venous thrombosis(4.00% vs. 8.00%, χ^(2)=0.355, P=0.552). After 2 weeks of treatment, the levels of PT, APTT and Fib in both groups had no significant fluctuations compared with those before treatment(P>0.05). PAR, whole blood low shear viscosity and whole blood high shear viscosity in both groups decreased compared with those before treatment, and SF-36 scores increased compared with those before treatment, and the degree of decrease or increase in the observation group was greater than that in the control group(P<0.01). There was no significant difference in the total incidence of adverse reactions between the observation group and the control group(8.00% vs. 12.00%, χ^(2)=0.222, P=0.637). Conclusion The clinical effect of apixaban and low molecular weight heparin on the prevention of lower limb deep vein thrombosis after hip and knee replacement is similar, as well as the influence on blood coagulation function. However, the hemorheology index and SF-36 score of patients have been significantly improved, which is worthy of clinical application.