利伐沙班、低分子肝素对四肢血管吻合术后下肢深静脉血栓的临床疗效对比

Comparison of clinical efficacy between rivaroxaban and low-molecular-weight heparin in the treatment of lower extremity deep vein thrombosis after limb vascular anastomosis surgery

目的 探讨利伐沙班、低分子肝素对四肢血管吻合术后下肢深静脉血栓(LDVT)的临床疗效。方法 收集2020年6月至2023年6月于青岛市第八人民医院行四肢血管吻合术的100例患者的临床资料,按照术后应用药物的不同将其分为低分子肝素组(n=46)与利伐沙班组(n=54)。比较治疗前、治疗14 d后两组患者凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D)],出院前统计两组患者LDVT发生情况,比较两组患者出血事件发生率。结果 治疗后,两组患者PT、APTT均长于本组治疗前,FIB、D-D水平均低于本组治疗前,且利伐沙班组患者D-D水平低于低分子肝素组患者,差异均有统计学意义(P﹤0.05)。利伐沙班组患者LDVT总发生率为1.85%(1/54),低于低分子肝素组患者的15.22%(7/46),差异有统计学意义(P﹤0.05)。两组患者出血事件总发生率比较,差异无统计学意义(P﹥0.05)。结论 与低分子肝素相比,利伐沙班可降低四肢血管吻合术患者LDVT的发生风险,安全可靠,值得临床进一步推广应用。

Objective To investigate the clinical effect of rivaroxaban and low molecular weight heparin on lower extremity deep vein thrombosis(LDVT)after vascular anastomosis of extremities.Method Clinical data of 100 patients who underwent limb vascular anastomosis surgery in the Eighth People's Hospital of Qingdao from June 2020 to June 2023 were collected and divided into low molecular weight heparin group(n=46)and rivaroxaban group(n=54)according to different postoperative drugs.The coagulation function indicators of activated partial thrombin time(APTT),prothrombin time(PT),fibrinogen(FIB)and D-dimer(D-D)were compared between the two groups before and 14 days after treatment.The incidence of LDVT in the two groups were counted before discharge,and the incidence of bleeding events in the two groups were compared.Result After treatment,the PT and APTT of two groups were longer than those before treatment,the levels of FIB and D-D were lower than those before treatment,and the level of D-D in the rivaroxaban group was lower than that of the low molecular weight heparin group,the differences were statistically significant(P<0.05).The total incidence of LDVT in patients treated with rivaroxaban group was 1.85%(1/54),lower than the low molecular weight heparin group of 15.22%(7/46),the difference was statistically significant(P<0.05).There was no statistically significant difference in the total incidence of bleeding events between the two groups(P>0.05).Conclusion Compared with low molecular weight heparin,rivaroxaban can reduce the risk of LDVT in patients undergoing limb vascular anastomosis,which is safe and reliable,it is worthy of further clinical promotion and application.