不同剂量利伐沙班对老年髋关节置换术患者凝血功能及下肢深静脉血栓的影响

目的:探讨不同剂量利伐沙班对老年髋关节置换术患者凝血功能及下肢深静脉血栓(DVT)的影响。方法:选择2013年6月~2016年6月期间我院收治的200例老年髋关节置换术患者,按随机数字表法分为两组各100例,术后分别予利伐沙班5 mg、10mg口服以预防DVT。术前及术后1d、7d检测纤维蛋白原(Fbg)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶原时间(APTT)及D-二聚体(D-D),同时行下肢彩色多普勒超声检查判断DVT发生情况,观察临床出血事件。结果:术后1d两组Fbg水平明显降低,PT明显延长(均P0.05);术后7d两组Fbg水平与术后1d相比明显回升,PT明显缩短(均P0.05)。两组各时期的Fbg与PT均无明显差异(P0.05)。术后1d两组D-D水平均明显升高(P0.05),且利伐沙班5 mg组明显高于利伐沙班10 mg组(P0.05);术后7d两组D-D水平均较术后1d明显降低(P0.05),且利伐沙班10 mg组明显低于利伐沙班5 mg组(P0.05)。利伐沙班10 mg组术后早期DVT发生率明显低于利伐沙班5 mg组(P0.05)。两组预防性抗凝后临床出血事件的发生率比较无统计学差异(P0.05)。结论:老年髋关节置换术后口服大剂量(10 mg)利伐沙班,可有效改善血液高凝状态,降低DVT发生率,且不会明显增加临床出血事件,值得推广。

Hip Replacement: Effects of Different Doses of Rivaroxaban on Coagulation Function and Deep Venous Thrombosis in Elderly Patients

ABSTRACT Objective: To investigate the effects of different doses of rivaroxaban on coagulation function and deep venous thrombosis (DVT) in elderly patients undergoing hip replacement. Methods: A total of 200 patients, who underwent hip replacement in Jingzhou Central Hospital of Hubei Province from June 2013 to June 2016, were selected and randomly divided into group I(n=100) and group II(n=100). After surgery, group I and group II were treated with 5 mg and 10 mg rivaroxaban orally to prevent DVT. Fibrinogen (Fbg), prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT) and D-dimer (D-D) were detected before surgery and 1d and 7d after surgery. At the same time, lower extremity color Doppler ultrasound was used to determine the occurrence of DVT, the clinical bleeding events were observed. Results: The levels of Fbg in the two groups were decreased significantly 1d after surgery, and PT was significantly prolonged (all P<0.05). 7d after surgery, the levels of Fbg in the two groups were significantly higher than those of 1d after surgery, and PT was significantly shortened (all P<0.05). There were no significant differences in Fbg and PT between the two groups in each period (P>0.05). The levels of D-D were significantly increased in the two groups 1d after surgery (P<0.05), and group I was higher than group II (P<0.05). The levels of D-D in the two groups 7d after surgery were significantly lower than those 1d after operation (P<0.05), and group II was lower than that group I (P<0.05). The incidence of early DVT in group II was significantly lower than that in group I (P<0.05). There was no significant difference in the incidence of clinical bleeding events after prophylactic anticoagulation between the two groups (P>0.05). Conclusion: Oral high dose (10 mg) rivaroxaban after hip arthroplasty in elderly patients can effectively improve the hypercoagulable state and reduce the incidence of DVT, and will not significantly increase the clinical bleeding events, which is worth popularizing.