不同剂量利伐沙班对高龄骨科术后患者凝血功能及静脉血栓栓塞症的影响

Effects of different doses of Rivaroxaban on coagulation function and venous thromboembolism in elderly patients after orthopedic surgery

目的:比较不同剂量利伐沙班对高龄骨科术后患者凝血功能及静脉血栓栓塞症(VTE)的影响。方法:回顾性分析2021年12月至2022年12月该院收治的119例高龄骨科患者的临床资料,按照不同剂量利伐沙班分为低剂量组(10 mg/d)40例、中剂量组(15 mg/d)38例、高剂量组(20 mg/d)41例。比较三组手术前后凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、D-二聚体(D-D)]水平、VTE发生率和不良反应发生率。结果:术后1、35 d,三组PT、APTT、TT水平均高于术前,但组间比较,差异无统计学意义(P>0.05);术后1、35 d,三组D-D水平均高于术前,且低剂量组高于高剂量组和中剂量组,差异有统计学意义(P<0.05);三组VTE发生率比较,差异无统计学意义(P>0.05);低剂量组与中剂量组不良反应发生率比较,差异无统计学意义(P<0.05);高剂量组不良反应发生率高于低剂量组和中剂量组,差异有统计学意义(P<0.05)。结论:不同剂量利伐沙班对高龄骨科术后患者VTE的影响总体相当,但10 mg/d剂量对凝血功能的D-D水平影响较大,20 mg/d剂量对不良反应影响较大。

Objective:To compare effects of different doses of Rivaroxaban on coagulation function and venous thromboembolism(VTE)in elderly patients after orthopedic surgery.Methods:The clinical data of 119 elderly orthopedic patients admitted to this hospital from December 2021 to December 2022 were retrospectively analyzed.According to different doses of Rivaroxaban,they were divided into low-dose group(10 mg/d,40 cases),medium-dose group(15 mg/d,38 cases)and high-dose group(20 mg/d,41 cases).The levels of coagulation function indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),D-dimer(D-D)],the incidence of VTE,and the incidence of adverse reactions were compared among the three groups before and after the surgery.Results:1 and 35 days after the surgery,the levels of PT,APTT and TT in the three groups were higher than those before the surgery,but there were no significant differences among the three groups(P>0.05).1 and 35 days after the surgery,the levels of D-D in the three groups were higher than those before the surgery,that of the low-dose group was higher than that of the high-dose group and the middle-dose group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the incidence of VTE among the three groups(P>0.05).There was no significant difference in the incidence of adverse reactions between the low-dose group and the middle-dose group(P<0.05).The incidence of adverse reactions in the high-dose group was higher than that in the low-dose group and the middle-dose group,and the differences were statistically significant(P<0.05).Conclusions:Different doses of Rivaroxaban have similar effects on VTE in the elderly patients after orthopedic surgery,but 10 mg/d dose has a greater influence on the D-D level of coagulation function,and 20 mg/d dose has a greater influence on the adverse reactions.