低分子肝素与利伐沙班预防骨转移癌术后下肢深静脉血栓的形成

背景：骨转移癌患者是下肢深静脉血栓形成的高危人群，大手术是血栓形成的重要的危险因素，此类患者术后预防性抗凝尚无标准化的方案。 目的：比较骨转移癌患者术后应用低分子肝素与利伐沙班预防下肢深静脉血栓形成的疗效和安全性。 方法：对2010年1月至2013年12月河北医科大学第三医院骨与软组织肿瘤科行开放手术治疗的73例脊柱、骨盆及下肢的骨转移癌患者进行回顾性分析。根据术后预防深静脉血栓使用药物将患者分为低分子肝素组（n=41）及利伐沙班组（n=32）。 结果与结论：低分子肝素组术后发生下肢深静脉血栓9例（22%），利伐沙班组发生下肢深静脉血栓6例（19%），差异无显著性意义（χ2=0.11，P=0.74）。2组患者出血事件发生率分别为7.32%和6.25%，差异无显著性意义（校正χ2=0.083，P〉0.05）。2组患者治疗前后血小板计数、活化部分凝血酶时间、凝血酶原时间比较，差异均无显著性意义（P〉0.05）。因此，低分子肝素和利伐沙班在预防骨转移癌患者术后下肢深静脉血栓的疗效与安全性相当。两者均可有效预防深静脉血栓的发生，并伴有一定的出血风险。

Low molecular weight heparins versus rivaroxaban for prevention of lower extremity deep venous thrombosis following surgery of bone metastases

BACKGROUND：The risk of lower extremity deep venous thrombosis was high in patients with bone metastases. Major surgery is a major risk factor for thrombosis. There was no standard prophylactic regimen available. OBJECTIVE：To investigate the efficacy and safety of low molecular weight heparins versus rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis in patients with bone metastases. METHODS：From January 2010 to December 2013, a total of 73 patients with bone metastasis in spine, pelvis and lower extremities, who underwent open surgery in the Department of Musculoskeletal Tumor, Third Hospital, Hebei Medical University, China, were retrospectively analyzed. The patients were divided into low molecular weight heparins group （n=41） and rivaroxaban group （n=32） according to the prophylactic drugs after surgery. RESULTS AND CONCLUSION：Nine cases （22%） in the low molecular weight heparins group were found lower extremity deep venous thrombosis, and six cases （19%） in the rivaroxaban group suffered from lower extremity deep venous thrombosis, showing no significant differences （χ2=0.11, P=0.74）. The incidences of bleeding events in both groups were respectively 7.32%and 6.25%, showing no significant differences （correctionχ2=0.083, P〉0.05）. There were no significant differences regarding the levels of platelet, activated partial thromboplastin time and prothrombin time between both groups preoperatively or postoperatively （P〉0.05）.＆amp;nbsp;Therefore, the efficacy and safety of low molecular weight heparins and rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis were similar. Both could effectively reduce the incidence of deep venous thrombosis, with a relative low risk of bleeding.