利伐沙班与低分子肝素预防髋关节置换术后深静脉血栓形成的疗效对比  

Compare prophylactic effects of rivaroxaban with low molecular heparin on deep vein thrombosis after hip replacement

作　　者：黄健斌[1] 曾采采[1] 丁悦[1] 曾展鹏[1] 马若凡[1] 李卫平[1] 

机构地区：[1]中山大学孙逸仙纪念医院骨外科,广东广州510120

出　　处：《中国新药与临床杂志》2011年第4期255-259,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的比较低分子肝素和利伐沙班预防髋关节置换术后患者深静脉血栓形成(DVT)的疗效。方法 89例髋关节置换术患者按术后预防DVT的方法分为3组。A组(n=21)未用任何抗凝药;B组(n=49)术后12h开始低分子肝素0.4mL皮下注射,每日1次,疗程7～10d;C组(n=19)术后12h开始利代沙班10mg口服,每日1次,疗程20～35d。观察3组术后出血量,手术前后血红蛋白、血小板、凝血酶原时间(PT)及活化部分凝血活酶时间(APTT),有症状DVT及药物不良反应的发生情况。结果 3组间术后出血量无显著差异(P>0.05)。3组患者血红蛋白均在术后d4有所下降,至术后d10基本恢复到术前水平。3组患者血小板均在正常范围内,B组患者术后d4血小板较术前显著升高(P<0.05),术后d10恢复至术前水平。3组手术前后PT和APTT均无明显改变。A组有症状DVT发生率(24%)高于B组(2%)和C组(0),差异有显著意义(P<0.05),B组和C组间无显著差异(P>0.05)。B组有3例患者出现术后尿素氮、肌酐明显升高,有1例患者出现术后嗜睡、低血压症状。结论利伐沙班可以有效预防髋关节置换术后DVT的发生,与低分子肝素的疗效相当,短期使用的安全性较好。AIM To compare the prophylactic effects of rivaroxaban with low molecular heparin on deep vein thrombosis（DVT） after hip replacement.METHODS Eighty-nine patients were divided into three groups according to the preventing methods from the DVT after hip replacement.Group A（n=21） were given no anticoagulant drug after hip replacement.Group B（n = 49） were given low molecular heparin 0.4 mL 12 h after hip replacement,im,qd for 7 - 10 d.Croup C（n = 19） were given rivaroxaban 10mg 12 h after hip replacement, po,qd for 20 - 35 d.Postoperative bleeding,the diversity of hemoglobin and platelet before and after the operation,pre- and postoperative prothrombin time（PT） and activated partial thromboplastin time（APTT）, incidence of symptomatic DVT and adverse reaction of the drugs were all retrospectively analyzed.RESULTS There was no significant difference of the amount of bleeding after operation among three groups（P0.05）. The hemoglobin level decreased in the fourth day,and recovered to the preoperative level in the tenth day after the operation in three groups.The platelet level was within normal limits after operation in three groups,and platelet level of group B increased obviously in the fourth day（P0.05）,and recovered to the preoperative level in the tenth day after the operation.There were no obvious changes of PT and APTT after operation in the three groups.There was significant difference of symptomatic DVT incidence among the three groups（P0.05）,which shown that group A was 24%,higher than group B（2%） and group C（0）.and there was no statistical difference between group B and C.CONCLUSION Rivaroxaban has similar effect on preventing DVT after hip replacement as low molecular heparin and its short time usage is safe.

关 键 词：关节成形术 置换 髋 静脉血栓形成 肝素 低分子量 利伐沙班 

分 类 号：R973.2[医药卫生—药品]