白超文;郑欣;易林洪;朱正亚;张星晨;赵凤朝;郭开今;

• 1:徐州医科大学附属医院骨科

摘要(Abstract)：

[目的]通过血栓弹力图(TEG)评估利伐沙班应用于全髋关节置换术后抗凝治疗的疗效。[方法]选取2017年1月～2018年6月行全髋关节置换术的60例患者,随机分成利伐沙班组、依诺肝素钠组,每组30例。利伐沙班组口服利伐沙班10 mg,1次/d,术后6 h首次给药,连续应用35 d。依诺肝素钠组皮下注射依诺肝素钠4 000U,1次/d,术后6 h首次给药,连续治疗7 d,后改为口服利伐沙班10 mg,1次/d,共治疗35 d。分别比较两组间常规凝血功能指标、D-二聚体、纤维蛋白原降解产物、TEG指标和深静脉血栓发生情况。[结果]利伐沙班组内不同时间点TEG的K值、Alpha角、MA值和CI值差异均有统计学意义(P<0.05)。依诺肝素组内不同时间点R值、K值、Alpha角、MA值和CI值差异均有统计学意义(P<0.05)。术后7 d利伐沙班组D-二聚体低于依诺肝素钠组,差异有统计学意义(P<0.05)。术后7 d利伐沙班组R值显著高于依诺肝素钠组,MA值和CI值显著小于依诺肝素钠组,差异有统计学意义(P<0.05)。然而两组间传统凝血指标的差异无统计学意义(P>0.05)。[结论]利伐沙班预防THA患者术后高凝状态的疗效强于依诺肝素。动态监测TEG可以评估THA术后应用利伐沙班预防高凝状态的疗效,弥补了传统凝血检测的不足。

关键词(KeyWords)： 利伐沙班;血栓弹力图;全髋关节置换术

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(编号:81672148);; 江苏省卫生计生委面上科研课题(编号:H201528);; 江苏省科技厅社会发展重点项目(编号:BE2015627);; 江苏省卫计委青年医学人才项目(编号:QNRC2016801);; 中国博士后科学基金项目(编号:2016M591929,2017T100408)

作者(Author): 白超文;郑欣;易林洪;朱正亚;张星晨;赵凤朝;郭开今;

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参考文献(References)：

• [1]Kakkar AK,Brenner B,Dahl OE,et al.Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty:a double-blind,randomised controlled trial[J].Lancet,2008,372(9632):31-39.
• [2]Rd WR,Stewart DW,Slusher L,et al.Retrospective evaluation of postoperative bleeding events in patients receiving rivaroxaban after undergoing total hip and total knee arthroplasty:comparison with clinical trial data[J].Pharmacotherapy,2015,35(7):663-669.
• [3]Zou Y,Tian S,Wang Y,et al.Administering aspirin,rivaroxaban and low-molecular-weight heparin to prevent deep venous thrombosis after total knee arthroplasty[J].Blood Coagulation Fibrinolysis,2014,25(7):660.
• [4]Samuelson BT,Cuker A.Measurement and reversal of the direct oral anticoagulants[J].Blood Reviews,2016,31(1):77.
• [5]Bt S,Am C,Dm S,et al.Laboratory Assessment of the anticoagulant activity of direct oral anticoagulants(DOACs):a systematic review[J].Chest,2016,151(1):127.
• [6]Yang Y,Yao Z,Dai W,et al.Changes of thrombelastography in patients undergoing elective primary total knee and total hip replacement with low molecular heparin prophylaxis[J].J Orthop Surg Res,2014,9(1):1-6.
• [7]Bliden KP,Chaudhary R,Mohammed N,et al.Determination of non-Vitamin K oral anticoagulant(NOAC)effects using a newgeneration thrombelastography TEG 6s system[J].J Thromb Thrombolysis,2017,43(4):437-445.
• [8]Herrmann R,Thom J,Wood A,et al.Thrombin generation using the calibrated automated thrombinoscope to assess reversibility of dabigatran and rivaroxaban[J].Thrombosis Haemostasis,2014,111(5):989-995.
• [9]刘珂,刘晓潭,侯毅,等.血栓弹力图辅助评估膝关节置换术后抗凝药物疗效比较[J].中华实验外科杂志,2017,34(2):329-331.
• [10]杨军,董宝军,张福江,等.血栓弹力图、D-二聚体预测骨科大手术围手术期抗凝治疗终点并发DVT的诊断价值[J].中华骨科杂志,2015,35(8):801-807.