关节置换术后抗凝药物预防深静脉血栓及相关并发症的临床研究进展

抗凝药物有助于预防全髋关节置换术和全膝关节置换术后深静脉血栓形成,临床上最常使用的传统抗凝药物如低分子肝素、华法林等可以起到很好的预防效果。目前有一类新的口服抗凝药物已经用于临床,为关节置换术后患者带来了一种更方便、安全和有效预防血栓的治疗选择。本篇综述主要针对传统抗凝药物低分子肝素及维生素K拮抗剂,直接凝血酶抑制剂达比加群,以及选择性Xa因子抑制剂利伐沙班和阿哌沙班,对迄今为止传统抗凝药物在全髋关节置换术和全膝关节置换术患者中的临床使用经验、优缺点、以及新型口服抗凝药物最新临床用药进展进行综述,为关节置换术后患者预防深静脉血栓提供用药参考。

Clinical Research Progress of Anticoagulants for Prophylaxis of Deep Vein Thrombosis and Complications after Arthroplasty

Anticoagulants are useful for preventing deep vein thrombosis (DVT) after total hip arthroplasty and total knee arthroplasty. The traditional anticoagulants commonly used in clinical practice, e.g., low molecular weight heparin (LMWH) and warfarin, have produced favorable prophylactic effect. However, these conventional anticoagulants have various limitations. The introduction of a new class of oral anticoagulants into clinical use presents a more convenient therapeutic option with better safety and efficacy for thrombosis prophylaxis in patients who have undergone joint arthroplasty. This clinical review mainly addresses the conventional anticoagulants LMWH and vitamin K antagonists, the direct thrombin inhibitor dabigatran, and the selective factor Xa inhibitors rivaroxaban and apixaban, reviewing their clinical experience and latest advances in patients who have underwent total hip arthroplasty or total knee arthroplasty, and to provide a reference for them.