利伐沙班在恶性肿瘤预防性抗凝中的疗效评价

目的评价新型口服抗凝药物利伐沙班在恶性肿瘤患者预防性抗凝中的疗效。方法选择Khorana评分≥3分的血栓高危患者30例(高危组),Khorana评分1~2分的血栓中低危患者20例(中低危组),比较两组患者间凝血指标差异。高危组给予利伐沙班预防性抗凝(口服10mg/d),并比较该组用药前,用药4、24h后的凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、抗凝血酶(AT)、D-二聚体(D-dimer)、纤维蛋白与纤维蛋白原降解产物(FDP)、抗Ⅹa活性(Anti-Ⅹa)的差异,分析这些指标变化的临床意义。结果高危组患者用药前较中低危组PT、INR、D-dimer、FDP明显升高(P<0.05),APTT、FIB、TT、AT、Anti-Ⅹa差异无统计学意义(P>0.05)。高危组预防性抗凝4h后PT、INR、APTT、Anti-Ⅹa均明显升高(P<0.05),用药后24h与用药4h比较,差异有统计学意义(P<0.05)。结论对于恶性肿瘤血栓高危患者应进行预防性抗凝,利伐沙班预防性抗凝可抑制外源性、内源性两大凝血途径,从而降低血栓风险;不同个体间采用相同剂量利伐沙班预防性抗凝效果差异较大,建议采取个体化预防抗凝方案。

Evaluation of the efficacy of rivaroxaban in preventive anticoagulation of malignant tumors

Objective To evaluate the preventive anticoagulant effect of rivaroxaban in malignant tumors.Methods Thirty patients with high risk of thrombosis with Khorana score≥3(high risk group)and 20 patients with low and medium risk of thrombosis with Khorana score<3(low and medium risk group)were selected.The differences in coagulation indexes between the two groups were compared.Then,the high risk group was given rivaroxaban preventive anticoagulation(10 mg/d),before and after medication 4 hand 24 hin prothrombin time(PT),international standard ratio(INR),activated partial thromboplastin time(APTT),fibrinogen(FIB),thrombin time(TT),antithrombin(AT),D-dimer,fibrin and fibrinogen degradation product(FDP),anti Xa activity(anti Xa)were compared with the low and medium risk group,the clinical significance of these changes were analyzed.Results Patients in the high risk group before medication had significantly higher PT,INR,D-dimer,and FDP than those in the low and middle risk group(P<0.05).APTT,FIB,TT,AT,and Anti-Xa had no significant changes(P>0.05).PT,INR,APTT,and Anti-Xa were significantly increased in the prophylactic anticoagulation after 4 hin the high risk group(P<0.05),the group fell back to the pre-treatment level 24 hafter the treatment(P<0.05).Conclusion Prophylactic anticoagulation should be used in patients at high risk of malignant tumor thrombosis.Rivaroxaban prophylactic anticoagulation can inhibit the exogenous and endogenous coagulation pathways,thereby reducing the risk of thrombosis.The same anti-coagulant effect of rivaroxaban varies greatly between individuals,so it is suggested that individualized anticoagulation is more appropriate.