摘要
[目的]通过血栓弹力图(TEG)评估利伐沙班应用于全髋关节置换术后抗凝治疗的疗效。[方法]选取2017年1月～2018年6月行全髋关节置换术的60例患者,随机分成利伐沙班组、依诺肝素钠组,每组30例。利伐沙班组口服利伐沙班10 mg,1次/d,术后6 h首次给药,连续应用35 d。依诺肝素钠组皮下注射依诺肝素钠4 000U,1次/d,术后6 h首次给药,连续治疗7 d,后改为口服利伐沙班10 mg,1次/d,共治疗35 d。分别比较两组间常规凝血功能指标、D-二聚体、纤维蛋白原降解产物、TEG指标和深静脉血栓发生情况。[结果]利伐沙班组内不同时间点TEG的K值、Alpha角、MA值和CI值差异均有统计学意义(P<0.05)。依诺肝素组内不同时间点R值、K值、Alpha角、MA值和CI值差异均有统计学意义(P<0.05)。术后7 d利伐沙班组D-二聚体低于依诺肝素钠组,差异有统计学意义(P<0.05)。术后7 d利伐沙班组R值显著高于依诺肝素钠组,MA值和CI值显著小于依诺肝素钠组,差异有统计学意义(P<0.05)。然而两组间传统凝血指标的差异无统计学意义(P>0.05)。[结论]利伐沙班预防THA患者术后高凝状态的疗效强于依诺肝素。动态监测TEG可以评估THA术后应用利伐沙班预防高凝状态的疗效,弥补了传统凝血检测的不足。
[Objective]To assess the efficacy of rivaroxaban in prevention of hypercoagulability after total hip arthroplasty by using thromboelastography.[Methods]From January 2017 to June 2018,60 patients who underwent total hip arthroplasty were included into this study and randomly divided into the rivaroxaban group and the enoxaparin group with 30 patients in each group.Starting from 6 hours after surgery,patients in the rivaroxaban group were orally given rivaroxaban 10 mg once daily for 35 days,while those in the enoxaparin group were subcutaneously given enoxaparin 4 000 U once daily for the first 7 days,and then changed to orally rivaroxaban for the remaining 28 days.The parameters of routine coagulation checks,D-dimer,fibrinogen degradation products(FDP)and thromboelastography,as well as the occurrence of deep venous thrombosis(DVT)were compared between the two groups.[Results]There were significant differences in the levels of K,Alpha angle,MA and CI of TEG in the rivaroxaban group and the levels of R,K,Alpha angle,MA and CI of TEG in the enoxaparin group between different time points.At 7 days after operation,the rivaroxaban group proved significantly lower D-dimer than the enoxaparin group(P<0.05).In term of thromboelastography,the R value in the rivaroxaban group was significantly higher than that in the enoxaparin group at 7 days postoperatively(P<0.05),whereas the MA and CI in the rivaroxaban group was significantly less than that in the enoxaparin group at 7 days after operation(P<0.05).However,there were no statistically significant differences regarding to any variable of conventional coagulation test between the two groups(P>0.05).[Conclusion]The efficacy of rivaroxaban for preventing postopera-tive hypercoagulability in THA patients is superior to enoxaparin.Dynamic thromboelastography is an effective tool to assess hypercoagulability after THA,which does overcome the deficiency of conventional coagulation test.
作者
白超文
郑欣
易林洪
朱正亚
张星晨
赵凤朝
郭开今
BAI Chao-wen;ZHENG Xin;YI Lin-hong;ZHU Zheng-ya;ZHANG Xing-chen;ZHAO Feng-chao;GUO Kai-jin(Department of Orthopedics,Affiliated Hospital,Xuzhou Medical University,Xuzhou221006,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第7期582-586,共5页
Orthopedic Journal of China
基金
国家自然科学基金项目(编号:81672148)
江苏省卫生计生委面上科研课题(编号:H201528)
江苏省科技厅社会发展重点项目(编号:BE2015627)
江苏省卫计委青年医学人才项目(编号:QNRC2016801)
中国博士后科学基金项目(编号:2016M591929
2017T100408)
