利伐沙班和低分子肝素在下肢骨折中预防下肢深静脉血栓形成的安全性及疗效  

The safety and effect of rivaroxaban and low molecular weight heparin in preventing lower extremity deep vein thrombosis in patients with lower extremity fractures

作　　者：孙伟文 杜新辉[1] 邱忠鹏[1] 卢阳阳 艾力 李刚[1] SUN Wei-wen;DU Xin-hui;QIU Zhong-peng;LU Yang-yang;AI Li;LI Gang(Dept of Traumatology,the First Affiliated Hospital of Shihezi University Medical College,Shihezi,Xinjiang 832000,China)

机构地区：[1]石河子大学医学院第一附属医院创伤外科,新疆石河子832000

出　　处：《临床骨科杂志》2021年第6期818-821,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较利伐沙班和低分子肝素在下肢骨折中预防下肢深静脉血栓形成(DVT)的安全性及疗效。方法将120例下肢骨折(包括骨盆髋臼骨折、股骨干骨折、股骨髁骨折、髌骨骨折及胫骨平台骨折)患者采用随机数字表法分为两组:①A组:60例,入院至术前12 h口服利伐沙班10 mg/d,术后8~12 h开始10 mg/d口服至出院。②B组:60例,入院至术前12 h皮下注射低分子肝素4100 IU/d,术后8~12 h开始4100 IU/d皮下注射至出院。结果术后DVT发生率A组低于B组(P<0.05)。凝血指标:术后第1天,凝血酶原时间、活化部分凝血活酶时间、组织型纤溶酶原激活剂物抗原指标A组均高于B组(P<0.05);血浆纤维蛋白原、血小板、D-二聚体指标两组比较差异均无统计学意义(P>0.05)。感染指标:术后第1天,降钙素原、C-反应蛋白指标A组均低于B组(P<0.001);白细胞计数、红细胞沉降率、白细胞介素6指标两组比较差异均无统计学意义(P>0.05)。结论低分子肝素与利伐沙班在下肢骨折患者中预防DVT均具有较好的抗凝疗效及安全性,从药物效果的角度分析,利伐沙班预防DVT发生的效果更好。Objective To compare the safety and efficacy of rivaroxaban and low molecular weight heparin(LMWH)in the prevention of deep venous thrombosis(DVT)of lower limbs fractures.Methods The 120 patients with lower limb fractures(including pelvic acetabular fracture,femoral shaft fracture,femoral condyle fracture,patellar fracture and tibial plateau fracture)were divided into two groups by random number table method:①Group A:60 patients received rivaroxaban,10 mg/d orally 12 h before admission,and 10 mg/d orally for 8~12 h after operation until discharge.②Group B:60 patients received LMWH,and received 4100 IU/d subcutaneously 12 h before admission,and 4100 IU/d subcutaneously for 8~12 h after operation until discharge.Results The incidence rate of DVT in group A was lower than that in group B(P<0.05).Coagulation indexes:at 1 d postoperation,PT,APTT and TPA-Ag indexes in group A were higher than those in group B(P<0.05).There were no significant differences in FIB,PLT and D-D between the two groups(P>0.05).Infection indexes:at 1 d postoperation,PCT and CRP indexes in group A were lower than those in group B(P<0.001).There were no significant differences in WBC,ESR and IL-6 between the two groups(P>0.05).Conclusions Both rivaroxaban and LMWH have good anticoagulant efficacy and safety in the prevention of DVT in patients with lower limb fracture.From the perspective of drug effect,rivaroxaban has better effect on the prevention of DVT.

关 键 词：利伐沙班 低分子肝素 深静脉血栓 下肢骨折 

分 类 号：R683.42[医药卫生—骨科学] R619.2[医药卫生—外科学]