个体化剂量利伐沙班用于髋关节置换术后血栓预防的临床效果

摘要

Objective To explore the efficacy and safety of adjusting rivaroxaban dose for preventing deep vein thrombosis(DVT) according to extreme body mass in the patients with orthopedic surgery.Methods One hundred and two patients undergoing the first time total hip arthroplasty(THA) from January 2014 to December 2016 included 102 cases of body mass ＜50 kg and 27 cases of body mass ＞100 kg,which were divided into the experimental subgroup and control subgroup respectively.Each subgroup was given different doses of rivaroxaban for 35 d.The coagulation function,hemoglobin,D-dimer change,bleeding events and VTE incidence rate were recorded.Results The extension values of PT and APTT had no statistically significant difference between the experimental group and control group(P＞0.05).Hb and PLT in the ＜50 kg group were decreased,and the incision drainage amount was less than that in the ＜50 kg group,the intra-group comparison in the ＞100 kg group had no statistical difference (P＞0.05).All cases had no bleeding in other sites.The difference of DVT and PE occurrence had no statistical significance(P＞0.05).Conclusion Adjusting the rivaroxaban dose according to the extreme body mass can effectively prevent the DVT occurrence after orthopedic operation and reduces the occurrence rate of adverse drug reactions.%目的 探索根据极端体质量调整利伐沙班用量预防骨科大手术后深静脉血栓(DVT)的疗效及安全性.方法 2014年1月至2016年12月初次行全髋关节置换术(THA)的患者102例,＜50 kg的患者75例,＞100 kg的患者27例.＜50 kg、＞100 kg两组分别再分为试验组和对照组两个亚组,给予4组不同剂量利伐沙班,用药35 d.记录凝血功能、血色素、D-二聚体变化,以及出血事件及静脉血栓栓塞症(VTE)发生率.结果 试验组和对照组的PT延长值、APTT延长值比较差异无统计学意义(P＞0.05).＜50 kg试验组Hb、PLT下降,以及切口引流量少于＜50 kg对照组,＞100 kg组组内比较差异无统计学意义(P＞0.05).所有患者均无其他部位出血,DVT和肺栓塞(PE)发生率＜50 kg组组内、＞100 kg组组内比较差异无统计学意义(P＞0.05).结论 根据极端体质量调整利伐沙班用量可以有效预防骨科大手术后DVT的发生,并降低药物不良反应的发生率.