延长疗程利伐沙班预防初次髋关节置换术后静脉血栓栓塞症的临床观察  

Prolonged prophylaxis for venous thromboembolism using rivaroxaban after primary total hip arthroplasty

作　　者：赵辉[1] 吴海山[1] 吴宇黎[1] 李晓华[1] 钱齐荣[1] 王波[1] 

机构地区：[1]上海长征医院骨科,上海200003

出　　处：《中国骨与关节外科》2016年第1期31-34,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景：静脉血栓栓塞症（VTE）是全髋关节置换（THA）术后常见的严重并发症，包括肺栓塞（PE）和深静脉血栓（DVT），是患者围手术期死亡的主要原因之一。目前针对髋关节置换术后VTE预防的疗程存在争议，延长疗程有望获得更好的预防效果，但潜在不良反应发生率可能增加。目的：观察延长疗程利伐沙班预防THA术后VTE的临床疗效，同时严格评估潜在不良事件，为延长疗程利伐沙班预防THA术后VTE提供临床依据。方法：回顾性研究2010年4月至2012年12月接受初次单侧THA患者876例。术前常规行双下肢彩色多普勒检查，评估VTE风险和出血风险。无出血高危因素患者接受常规预防VTE，术后8 h皮下注射低分子肝素4000 IU，此后每日1次，持续3 d；术后第4天改为口服利伐沙班10 mg，每日1次，持续至术后3周随访。出院前、术后3周及6周门诊随访时亦行双下肢彩色多普勒检查，评估双下肢DVT形成情况，并记录预防治疗期间的不良反应及出血情况。结果：共127例患者在初次单侧THA术后进行延长疗程利伐沙班预防VTE，男51例，女76例；平均年龄（58.5±12.4）岁（44-76岁）；总疗程平均为（33.0±3.2）d （29-35 d）。术后6周治疗期内经下肢彩色多普勒检查确认的下肢DVT发生率为8.7%（11/127），治疗期间未发生PE或严重出血。结论：初次THA患者接受延长疗程的利伐沙班预防VET的疗效确切，可有效降低有症状和无症状VET的发生率，未明显增加出血事件风险，应成为初次THA术后VET高危患者的选择之一。Background：Venous thromboembolism （VTE） including pulmonary embolism （PE） and deep vein thrombosis （DVT）, is a severe complication and the main cause of death after total hip arthroplasty （THA）. There is some controversy over the duration of VTE prevention after THA. Prolonged prevention would achieve better effect while the incidence of po-tential adverse events would increase as well. Objective：The aim of this retrospective study is to observe the clinical outcome of prolonged prophylaxis schedule for VTE using rivaroxaban after THA, and to evaluate potential adverse events, which would provide clinical evidence for prolonged application of rivaroxaban for prevention of VTE after THA. Methods：A total of 876 patients who received unilateral primary THA from April 2010 to December 2012 were retrospectively collected. Color Doppler examination was routinely performed to evaluate the risks of VTE and bleeding. Patients without high risks of bleeding received routine VTE prevention： low molecular weight heparin 4000 IU was subcutaneously given at 8 h after THA, and once a day for three days;rivaroxaban 10 mg was orally taken on the fourth day after surgery, which continued until 3 week safter THA. Color Doppler examination of lower limbs was performed before discharge, at 3 weeks and 6 weeks after THA. Adverse reactions and bleeding were recorded during follow up. Results：A total of 127 patients received prolonged prophylaxis of VTE using rivaroxaban after unilateral primary THA. There were 51 males and 76 females with an average age of （58.5±12.4） years （range, 44-76 years）. The mean duration of VTE prevention was （33.0±3.2） d in （range, 29-35 d）. Eleven patients were diagnosed as DVT through color Doppler examination 6 week after THA and the incidence of DVT was 8.7%（11/127）. No PE or severe bleeding events occurred. Conclusions：Prolonged proxphylaxis of VTE using ri-varoxaban can effectively reduce the incidence of symptomatic and asymptomatic VTE after unilateral

关 键 词：关节成形术 置换 髋 静脉血栓栓塞 

分 类 号：R687.4[医药卫生—骨科学] R543.6[医药卫生—外科学]