利伐沙班与低分子肝素对髋关节置换术后并发症的影响

Comparison of Rivaroxaban and Low Molecular Heparin on Complications after Hip Replacement

关键词:  利伐沙班  低分子肝素  髋关节置换术  并发症  深静脉血栓

Key words:  rivaroxaban  low molecular heparin  hip replacement  complication  deep vein thrombosis

摘要:

目的 比较利伐沙班和低分子肝素在预防全髋关节置换术术后对患者深静脉血栓(DVT)形成的影响及疗效。方法 126例行全髋关节置换术的患者随机分为利伐沙班组和低分子肝素组。低分子肝素组(n=70)术前12 h或术后24 h给予低分子肝素注射液，皮下注射，40 mg，1 次·d^-1，连续给药14 d。利伐沙班组(n=56)术后6~8 h给予利伐沙班口服，10 mg，1次·d^-1，连续给药35 d。观察2组术中出血量和术后引流量，比较2组的安全性指标以及术后DVT的发生率。结果 2组术中出血量、术后引流量、术后下肢DVT发生率比较差异无统计学意义(P>0.05)。利伐沙班组增加了患者术后出血、切口感染、切口不愈合或延期愈合等不良事件的风险，与低分子肝素组比较差异有统计学意义(P<0.05)。结论 在全髋关节置换术后预防DVT方面，利伐沙班和低分子肝素的疗效相似，但术后伤口并发症发生率明显高于低分子肝素，使用利伐沙班的安全性需要进一步验证。

Abstract:

OBJECTIVE To compare the prophylactic effects of rivaroxaban and low molecular heparin on deep vein thrombosis(DVT) after hip replacement. METHODS All of 126 patients were divided into two groups randomly. Low molecular heparin group(n=70) were given low molecular heparin 40 mg before 12 h or after 24 h of hip replacement, ic, then qd, for 14 d. Rivaroxaban group(n=56) were given rivaroxaban 10 mg after 6-8 h of hip replacement, po, qd for 35 d. The postoperative bleeding and postoperative flow in the two groups were observed. The safety index and incidence of postoperative DVT were compared. RESULTS There were no significant differences of the amount of bleeding, the flow during operation, and the incidence of DVT among the two groups(P>0.05). There was significant difference of postoperative bleeding, incision infection, incision healing rate of the two groups(P<0.05), which showed that rivaroxaban group were higher than low molecular heparin group. CONCLUSION Rivaroxaban has similar effect of preventing DVT after hip replacement with low molecular heparin, but the incidence of complication is higher than low molecular heparin. Thus, the safety usage of rivaroxaban should be more researched.