D-二聚体异常患者人工全膝关节置换术后利伐沙班药物抗凝的安全性和有效性分析  

SAFETY AND EFFICACY OF RIVAROXABAN FOR PREVENTION OF DEEP VEIN THROMBOSIS IN PATIENTS WITH PREOPERATIVE ABNORMAL D-DIMER AFTER TOTAL KNEE ARTHROPLASTY

作　　者：孙云波[1] 王磊[1] 神兴勤[1] 张东亮[1] 刘军[1] 孙振辉[1] 

机构地区：[1]天津市人民医院关节外科,天津300121

出　　处：《中国修复重建外科杂志》2014年第8期955-959,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨D-二聚体异常患者行人工全膝关节置换术（total knee arthroplasty，TKA）后采用利伐沙班药物抗凝的安全性和有效性。 方法将2013年8月－9月收治的60例（60膝）符合选择标准的膝关节内翻型骨关节炎患者纳入研究，根据术前D-二聚体水平分为两组：D-二聚体正常组（对照组，41例）和D-二聚体异常组（试验组，19例）。两组患者性别、年龄、体重指数、术前膝关节活动度等一般资料比较，差异均无统计学意义（P 〉 0.05），具有可比性。患者均行常规TKA，术后采用利伐沙班药物抗凝。比较两组术中止血带使用时间、术后住院时间以及总住院时间；术后1、3、5 d抽血检测血浆凝血酶原时间（prothrombin time，PT）、活化部分凝血酶时间（activated partial thromboplastin time，APTT）、血浆凝血酶时间（thrombin time，TT）以及血浆纤维蛋白原（fibrinogen，FIB）和D-二聚体水平；观察切口并发症及双下肢深静脉血栓形成（deep vein thrombosis，DVT）情况。 结果试验组术后住院时间较对照组显著延长（t=2.327，P=0.031）；两组止血带使用时间及总住院时间比较，差异均无统计学意义（P 〉 0.05）。两组患者均获随访，随访时间6～8 个月，平均7.2个月。术后对照组3例（7.3%）、试验组2例（10.5%）发生切口并发症，发生率比较差异无统计学意义（χ2=0.175，P=0.676）。术后两组患者均未出现肺栓塞相关事件，6周行双下肢静脉彩超均未发现DVT。PT、TT、FIB：组内比较手术前后存在时间变化趋势，组间比较差异无统计学意义；APTT、D-二聚体：组内比较手术前后存在时间变化趋势，组间比较差异有统计学意义；各指标时间与组别交互作用均无统计学意义。结论术前D-二聚体高于正常值不应视为TKA手术禁忌证；该类患者术后采用利伐沙班药物抗凝，其发生DVT、伤口并发症的几率与D-�Objective To evaluate the safety and efficacy of rivaroxaban for prevention of deep vein thrombosis （DVT） in patients with preoperative abnormal D-dimer after total knee arthroplasty （TKA）. Methods Between August and September 2013, 60 consecutive patients with varus knee osteoarthritis undergoing unilateral TKA were enrolled in the study. According to the preoperative D-dimer level, the patients were divided into 2 groups： D-dimer normal group （control group, n=41） and D-dimer abnormal group （test group, n=19）. No significant difference was found in gender, age, body mass index, and preoperative knee range of motion between 2 groups （P 〉 0.05）. All patients underwent conventional primary TKA and anticoagulation therapy with rivaroxaban to prevent DVT. The tourniquet use time, postoperative hospitalization time, and total hospitalization time were compared between 2 groups. At 1, 3, and 5 days after operation, prothrombin time （PT）, activated partial thromboplastin time （APTT）, thrombin time （TT）, fibrinogen （FIB）, and D-dimer were measured. Wound complications and DVT were observed. Results The postoperative hospitalization time of the test group was significantly longer than that of the control group （t=2.327, P=0.031）, while the tourniquet use time and total hospitalization time showed no significant difference between 2 groups （P 〉 0.05）. All the patients were followed up 6-8 months （mean, 7.2 months）. Wound complications occurred in 3 cases （7.3%） of the control group and in 2 cases （10.5%） of the test group, showing no significant difference （χ2=0.175, P=0.676）. Color ultrasonography showed no pulmonary embolism and DVT at 6 weeks after TKA. There were significant differences in PT, TT, and FIB between at pre- and post-TKA in the same group, but no significant difference was found between 2 groups. The APTT and D-dimer had significant differences between at pre- and post-TKA in the same group, and between groups. There was no significant int

关 键 词：人工全膝关节置换术 D-二聚体 深静脉血栓形成 利伐沙班 

分 类 号：R687.4[医药卫生—骨科学]