赵志刚;谢林;丁凡;郭卫春;

• 1:武汉大学人民医院骨一科
• 2:华中科技大学同济医学院附属普爱医院骨科

摘要(Abstract)：

[目的]探讨关节置换后口服利伐沙班预防下肢深静脉血栓的疗效与安全性。[方法]选取2013年2月~2015年1月本院骨科住院并行髋关节或膝关节置换术的68例患者作为研究对象,其中术后口服利伐沙班抗凝者(利伐沙班组)30例,应用皮下注射低分子肝素抗凝者(低分子肝素组)38例。利伐沙班组术后6 h开始给予利伐沙班10 mg·d-1,口服连续5周;低分子肝素组术后12 h皮下注射低分子肝素4 100 IU,1 d/次,连续14 d。术后随访6个月,评价两组患者下肢静脉血栓发生风险、术后引流量、术后1周出凝血功能及不良反应有无差别。[结果]利伐沙班组6个月内发生下肢静脉血栓5例,发生率为16.67%,低分子肝素组发生6例,发生率为15.79%,两组患者下肢静脉血栓发生风险差异无统计学意义(HR=1.25,95%CI:0.40-3.93,P>0.05);利伐沙班组和低分子肝素组术后引流量分别为(1 120.36±186.32)ml和(1 456.66±268.45)ml,利伐沙班组引流量显著低于低分子肝素组(P<0.05);术后1周两组患者凝血指标差异无统计学意义(P>0.05)。[结论]口服利伐沙班可明显降低关节置换术后下肢静脉血栓风险,与低分子肝素疗效无显著差异,且减少术后引流量。

关键词(KeyWords)： 利伐沙班;关节置换术;下肢静脉血栓;低分子肝素;出血风险

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 赵志刚;谢林;丁凡;郭卫春;

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参考文献(References)：

• [1]Burness CB,Perry CM.Rivaroxaban:a review of its use in the treatment of deep vein thrombosis or pulmonary embolism and the prevention of recurrent venous thromboembolism[J].Drugs,2014,74(2):243-262.
• [2]陆慧杰,庄汝杰,陈之青.利伐沙班对比依诺肝素预防骨科大手术后深静脉血栓形成的疗效与安全性评价[J].中国临床药理学杂志,2015,31(9):693-695.
• [3]Rathbun S.Cardiology patient pages.The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism[J].Circulation,2009,119(15):480-482.
• [4]Lowe GD,Haverkate F,Thompson SG,et al.Prediction of deep vein thrombosis after elective hip replacement surgery by preoperative clinical and haemostatic variables:the ECAT DVT Study.European Concerted Action on Thrombosis[J].Thromb Haemost,1999,81(6):879-886.
• [5]Donnell M,Linkins LA,Kearon C,et al.Reduction of out-of-hospital symptomatic venous thromboembolism by extended thromboprophylaxis with low-molecular-weight heparin following elective hip arthroplasty:a systematic review[J].Arch Int Med,2003,163(11):1362-1366.
• [6]赵崇高,郭继学,冯兰英.肝素在预防老年髋骨骨折患者下肢静脉血栓形成中血浆凝血指标的检测与分析[J].中医正骨,2005,17(9):13-15.
• [7]Roehrig S,Straub A,Pohlmann J,et al.Discovery of the novel antithrombotic agent thiophene-2-carboxamide(BAY 59-7939):an oral,direct factor Xa inhibitor[J].J Med Chem,2005,48(19):5900-5908.
• [8]Eriksson BI,Borris LC,Dahl OE,et al.Rivaroxaban for prevention of venous thromboembolism after hip replacement:a phase IIa proof of principle study[J].Pathophysiol Haemost Thromb,2006,35(1):A33.
• [9]Harder S.Pharmacokinetic and pharmacodynamic evaluation of rivaroxaban:considerations for the treatment of venous thromboembolism[J].Thromb J,2014,12(1):22.
• [10]Eriksson BI,Rosencher N,Friedman RJ,et al.Concomitant use of medication with antiplatelet effects in patients receiving either rivaroxaban or enoxaparin after total hip or knee arthroplasty[J].Thromb Res,2012,130(2):147-151.
• [11]杨礼庆,王程,沈涛,等.口服利伐沙班预防人工全髋关节置换术后深静脉血栓的临床研究[J].中国临床药理学杂志,2013,29(4):260-262.
• [12]关振鹏,吕厚山,陈彦,等.影响人工关节置换术后下肢深静脉血栓形成的临床风险因素分析[J].中华外科杂志,2005,43(20):1317-1320.