利伐沙班治疗髋膝关节置换术后下肢肌间静脉血栓的有效性与安全性研究

目的观察利伐沙班治疗髋膝关节置换术后下肢肌间静脉血栓的有效性与安全性。 方法选取2016年01月~2017年12月，单侧髋/膝关节置换术后出现下肢肌间静脉血栓患者220例。随机分为试验组与对照组，每组110例，试验组在物理治疗的基础上给予利伐沙班10 mg/次，口服，一天两次；对照组在物理治疗的基础上给予利伐沙班10 mg/次，口服，一天一次。观察治疗后3、7、14 d，下肢肌间静脉血栓的溶解效率及下肢出现瘀斑、切口感染、切口周围血肿等出血倾向事件的发生率。 结果所有患者均完成随访，两组患者一般资料差异没有统计学意义（P>0.05）。治疗后3、7、14 d，试验组的溶栓效率分别为32.73%、55.45%、70%，高于对照组的1.82%、12.73%、25.45%，两组之间的差异具有统计学意义（P<0.05）。治疗3 d后，两组血栓的硬度均较软（以红色为主，P>0.05），7 d时试验组血栓的硬度（2.63±0.67）高于对照组（1.95±0.92），两组之间的差异具有统计学意义（t=7.633；P<0.001），而14 d后两组下肢肌间静脉血栓的硬度均高于平均硬度（以蓝绿色为主，P>0.05）。两组患者手术前后红细胞计数与血红蛋白的差异变化没有统计学意义（P>0.05）。两组患者出现下肢瘀斑的概率分别是18.06%、18.42%，差异无统计学意义（χ²=0.003；P=0.95）。所有患者均未出现切口感染、切口周围血肿。 结论高剂量利伐沙班（20 mg）联合物理压力治疗髋膝关节置换术后下肢肌间静脉血栓安全有效。

Efficacy and safety of rivaroxaban in the treatment of lower extremity calf muscle vein thrombosis after hip/knee arthroplasty

ObjectiveTo observe the efficacy and safety of rivaroxaban in the treatment of lower extremity calf muscle vein thrombosis after total hip/knee arthroplasty. MethodsFrom January 2016 to December 2017, 220 patients with lower extremity calf muscle vein thrombosis after unilateral total hip/knee arthroplasty were selected. They were randomly divided into the experimental group and the control group, with 110 cases in each group. The experimental group was given rivaroxaban 10 mg(po bid), on the basis of physical therapy. The control group was given rivaroxaban 10 mg(po qd), on the basis of physical therapy. At 3rd, 7th and 14th day after treatment, the dissolution rate of lower extremity calf muscle vein thrombosis and the incidence of bleeding tendency events such as ecchymosis, incision infection, and hematoma around the incision were observed. ResultsAll patients were followed up. There was no statistically significant difference in basic informations between the two groups (P>005). At 3rd, 7th and 14th day after treatment, the thrombolytic efficiencies of the experimental group were 32.73%, 55.45% and 70%, respectively, which were higher than 1.82%, 12.73% and 25.45% of the control group. The difference between the two groups was statistically significant (P<0.05). After 3rd day of treatment, the hardness of the two groups of thrombus was soft (mainly red, P>0.05). At 7th day, the hardness of the experimental group (2.63±0.67) was higher than that of the control group (1.95±0.92). The difference was statistically significant (t=7.63, P<0.001), and after 14h day, the hardness of the lower extremity venous thrombosis was higher than the mean hardness (blue-green, P>0.05). There was no significant difference in the difference of red blood cell count and hemoglobin between the two groups before and after operation (P>0.05). The incidence of ecchymosis in the lower extremities was 18.06% and 18.42%, respectively, and the difference was not statistically significant (χ²=0.003, P=0.95). No incision infection or hematoma around the incision occurred in all patients. ConclusionHigh-dose rivaroxaban (20 mg) combined with physical pressure is safe and effective for the treatment of lower extremity calf muscle vein thrombosis after hip/knee arthroplasty.