不同剂量利伐沙班防治全髋关节置换术后深静脉血栓形成的效果比较

目的 探讨不同剂量利伐沙班对防治深静脉血栓(DVT)高危因素患者全髋关节置换术后DVT形成的影响.方法 选取2015年4月至2016年4月于佛山市中医院行全髋关节置换术的108例DVT高危患者为研究对象,所有患者均于术后予以利伐沙班口服防治方案.随机数字表法将其分成低剂量组(10 mg/次,qd)、中剂量组(20 mg/次,qd)和高剂量组(15 mg/次,bid)各36例.比较三组患者术后14 d内DVT发生率及不良反应发生情况,记录其术后即刻(T0)、3 d(T1)、7 d(T2)时凝血功能指标凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)]及血液流变学指标(血浆粘度、红细胞聚集指数)检测结果的差异.结果 术后14 d内,低剂量组DVT发生率为16.67%,明显高于高剂量组的2.78%(P<0.05),但与中剂量组的8.33%比较差异无统计学意义(P>0.05);三组患者的不良反应发生率分别为2.78%、2.78%和8.34%,差异无统计学意义(P>0.05);T0~T2时,三组患者的PT、APTT水平比较差异均无统计学意义(P>0.05);T1、T2时,三组患者的D-D水平均较T0时升高,且低剂量组高于高剂量,差异均有统计学意义(P<0.05),但低剂量组与中剂量组比较差异无统计学意义(P>0.05);T1、T2时,低剂量组血浆粘度、红细胞聚集指数水平均较T0时显著提高,差异均有统计学意义(P<0.05),而中、高剂量组上述指标分别与T0时比较差异均无统计学意义(P>0.05).结论 高剂量利伐沙班能有效降低全髋关节置换术后DVT形成风险,且不增加出血事件发生概率,于高危DVT形成患者的预后恢复有利.

Comparison of the effects of different doses of rivaroxiban in controlling deep venous thrombosis after total hip replacement

Objective To investigate the effects of different doses of rivaroxiban in controlling deep venous thrombosis (DVT) in high risk group after total hip replacement. Methods One hundred and eight patients with high risk of DVT who underwent total hip replacement in Hospital of Traditional Chinese Medicine of Foshan City during April 2015 and April 2016 were selected as the study subjects, and all of them were treated with oral administration of ri-varoxiban after surgery. By the random number table method, they were divided into low dose group (10 mg/time, qd), middle dose group (20 mg/time, qd) and high dose group (15 mg/time, bid), with 36 cases in each group. The incidence rates of DVT and adverse reactions 14 d after surgery were compared between the three groups. The coagulation func-tion indexes prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer (D-D)] and blood rheologi-cal indexes (plasma viscosity, erythrocyte aggregation index) were recorded immediately after surgery (T0), 3 d after sur-gery (T1) and 7 d after surgery (T2). Results In 14 d after surgery, the incidence of DVT in low dose group (16.67%) was significantly higher than that in high dose group (2.78%)(P<0.05), but compared with that in the middle dose group (8.33%), there was no significant difference (P>0.05). There was no significant difference in the incidence rates of adverse reactions among the three groups (2.78%, 2.78%and 8.34%, respectively, P>0.05). There were no significant differences in PT and APTT among groups at T0~T2 (P>0.05). At T1 and T2, D-D levels in the three groups were significantly higher than those at T0, and the levels in low dose group were higher than those in high dose group (P<0.05), with no significant difference between the low dose group and middle dose group (P>0.05). At T1 and T2, the plasma viscosity and erythro-cyte aggregation index in low dose group were significantly higher than those at T0 (P<0.05), but there were no significant changes of above-mentioned indexes in middle dose and high dose group (P>0.05). Conclusion High-dose rivaroxiban can effectively reduce the risk of DVT after total hip replacement, and does not increase the incidence of bleeding events, which is good for the prognosis of patients with high risk of DVT.