不同时限利伐沙班预防单侧全膝关节置换术后深静脉血栓形成的效果评价

摘要

Objective By comparing the efficacy of different courses of rivaroxaban for the prevention of lower deep vein thrombosis (DVT) after the first total knee arthroplasty (TKA), to evaluate the effectiveness and security of different courses of treatment with rivaroxaban. Methods Cases of 140 patients undergoing unilateral primary TKA from January 2013 to November 2013 were retrospectively analyzed, and divided into 2 weeks group (14 d) and 5 weeks group (35 d) depending on the courses of rivaroxaban. There were 32 males and 38 females in 2 weeks group, the average age was 63.80±8.22, and BMI was (24.32±4.45) kg/m2. There were 31 males and 39 females in 5 weeks group, the average age was 64.20±9.02, and BMI was (25.80±4.53) kg/m2. The coagulation conditions (PT, APTT, TT, Fib) on the preoperative and postoperative day 35, D⁃dimmer on the preoperative and postoperative day 1, 7, 14 and 35, the incidence of DVT, and minor and major bleeding event rate were compared. Results The PT, APTT, TT, Fib and D⁃dimer at the same time between two groups had no significant difference (P>0.05 for all). The differences in minor and major bleeding event rate between two groups was not statistically significant (χ2=0.672,P=0.412). The incidence of DVT in 2 weeks group was 11.43%(8/70), and 1.43%(1/70) in 5 weeks group (χ2=4.275,P=0.0387). Conclusion Rivaroxaban for taking the time was extended to 35 d is more effective in preventing the occurrence of lower extremity DVT after TKA.%目的：通过比较不同时限利伐沙班预防初次单侧人工膝关节置换术后下肢深静脉血栓形成（deep vein thrombosis, DVT）的效果，评估不同时限应用利伐沙班的有效性及安全性。方法对2013年1月至2013年11月我院骨科收治的140例初次行单侧全膝关节置换的患者进行回顾性分析，根据术后预防DVT使用利伐沙班的时限不同分为2周组（术后应用利伐沙班14 d）和5周组（术后应用利伐沙班35 d），每组70例。2周组男32例，女38例；平均年龄为（63.80±8.22）岁，身体质量指数（BMI）为（24.32±4.45）kg/m2。5周组男31例，女39例；平均年龄为（64.20±9.02）岁，BMI为（25.80±4.53）kg/m2。比较分析两组患者术前及术后35 d的凝血四项[血浆凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）]情况、术前及术后第1、7、14、35 d时D-二聚体情况以及DVT发生率、轻微和严重出血的发生率。结果两组患者的凝血四项、D-二聚体在相同时间点比较，差异均无统计学意义（均P＞0.05）。两组患者轻微和严重出血的发生率差异无统计学意义（χ2=0.672，P=0.412）。2周组的血栓发生率为11.43%（8/70），5周组为1.43%（1/70），5周组显著低于2周组，差异有统计学意义（χ2=4.275，P=0.0387）。结论利伐沙班的服用时间延长至35 d能更有效地预防人工膝关节置换术后下肢DVT的发生。