利伐沙班与低分子肝素对髋膝关节置换术后下肢深静脉血栓预防的应用评价

目的:通过对髋膝关节置换术术后病人分别使用利伐沙班和注射用低分子量肝素钙，来评价2种药物的临床疗效，进一步探讨临床药师在髋膝关节置换术术后的预防中，如何协助临床医生使用抗凝药物进行治疗。方法:收集100例髋、膝关节置换术的病人，随机分为利伐沙班组50例和低分子肝素组50例。利伐沙班组病人于术后8 h给予利伐沙班片10 mg，每天1次，口服；低分子肝素组病人于术后12 h给予低分子量肝素5 000抗Xa国际单位，每天1次，皮下注射。2组均连续治疗2周。观察比较2组病人的凝血指标血小板（PLT）、活化部分凝血活酶（APTT）、凝血酶原时间（PT）及下肢深静脉血栓（DVT）发生率。临床药师参与治疗过程并提供药学监护。结果:2组病人术前血小板及凝血指标均无异常，且2组间差异无统计学意义（P>0.05）。2组病人术后药物治疗前及治疗后14 d血小板及凝血指标均无异常，且2组间差异无统计学意义（P>0.05）。2组病人中利伐沙班组深静脉血栓形成（DVT）发生率为0%（0/50），低分子肝素组DVT发生率为8%（4/50），2组差异有统计学意义（P<0.05）。2组病人中利伐沙班组不良反应发生率为2%（1/50），低分子肝素组为12%（6/50），差异无统计学意义（P>0.05）。结论:利伐沙班能有效预防髋膝关节置换术后下肢深静脉血栓的发生，不增加出血风险，具有良好的安全性，其疗效与低分子肝素相当。且利伐沙班具备可口服、固定剂量、疗效满意、无需监测等优点。

Effect comparison between rivaroxaban and low molecular weight heparin in the prevention of deep venous thrombosis after hip and knee joint arthroplasty

Objective:To compare the clinical efficacy between rivaroxaban and low molecular weight heparin calcium injection in the prevention of deep venous thrombosis after hip and knee joint arthroplasty,and guide clinical rational use of anticoagulant.Methods:One hundred patients with hip and knee arthroplasty were randomly divided into the rivaroxaban group and low molecular weight heparin group(50 cases each group).The rivaroxaban group was treated with 10 mg of rivaroxaban once daily by oral after 8 hours of operation,and the low molecular weight heparin group was treated with 5 000 AXaIU of low molecular weight heparin once daily by subcutaneous injection after 12 hours of operation.Two groups were continuously treated for 2 weeks.The blood coagulation indexesincluding platelet,activated partial thromboplastin,prothrombin time and incidence rate of lower extremity deep venous thrombosis(DVT)] were compared between two groups.Clinical pharmacists participated in the treatment process,and provided pharmaceutical care.Results:The platelet counts and coagulation parameters in two groups were normal before surgery,and the difference of which was not statistically significant between two groups(P>0.05).The platelet counts and coagulation parameters in the two groups were normal before treatment and after 14 days of treatment,and the difference of which was not statistically significant between in two groups(P>0.05).The incidence rates of DVT in rivaroxaban group and low molecular weight heparin group were 0%(0/50) and 8%(4/50),respectively,and the difference of which was statistically significant between the two groups(P<0.05).The incidence rates of adverse reactions in rivaroxaban group and low molecular weight heparin group were 2%(1/50) and 12%(6/50),respectively,and the difference of which was not statistically significant between the two groups(P>0.05).Conclusions:Rivaroxaban can effectively prevent the occurrence of thrombosis in lower extremities deep vein after hip and knee joint arthroplasty,does not increase the risk of bleeding and has good safety,and the curative effect of which is equivalent to low molecular weight heparin.Rivaroxaban has the advantages of oral administration,fixed dose,satisfactory efficacy,and need not monitor.