利伐沙班与低分子肝素钙联合氨甲环酸对初次全膝关节置换术止血效果及安全性比较

Comparison of hemostatic effect and safety of rivaroxaban and low molecular weight heparin calcium combined with tranexamic acid on primary total knee arthroplasty

摘要:

目的 比较利伐沙班与低分子肝素钙联合氨甲环酸对初次全膝关节置换术（TKR）的止血效果及安全性。方法 选取2019年1月—2021年1月海南西部中心医院收治的214例TKR患者为研究对象，按照随机数字表法分为对照组和研究组，每组107例。所有患者TKR切皮前10 min静脉滴注氨甲环酸15 mg/kg。对照组TKR术后12 h注射0.4 mL低分子肝素钙，之后皮下注射0.4 mL，1次/d，持续2周；研究组TKR术后12 h口服利伐沙班10 mg为第1次给药，之后10 mg/d，1次/d，持续2周。比较两组患者的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、凝血反应时间（R）、凝集时间（K）、凝集块形成速率（α角）、最大振幅（MA）、全血高切黏度、血浆黏度、红细胞比容。统计两组术后并发症发生情况。结果 两组治疗前后的PT、APTT、FIB差值比较，差异无统计学意义（P >0.05）。两组治疗前后的R、K、α角、MA差值比较，差异无统计学意义（P >0.05）。两组患者的总失血量、隐性失血量、显性失血量比较，差异无统计学意义（P >0.05）。两组治疗前后的全血高切黏度、血浆黏度、红细胞比容差值比较，差异无统计学意义（P >0.05）。研究组总并发症发生率高于对照组（P <0.05）。结论 利伐沙班与低分子肝素钙联合氨甲环酸在初次TKR患者中的止血效果相近，但低分子肝素钙联合氨甲环酸的安全性更高。

Abstract:

Objective To compare the hemostatic effect and safety of rivaroxaban and low-molecular-weight heparin calcium combined with tranexamic acid on primary total knee arthroplasty (TKR).Methods From January 2019 to January 2021, 214 TKR patients admitted were selected as the research objects and divided into control group and study group by random number table method, with 107 cases in each group. All patients were received intravenous infusion of tranexamic acid 15 mg/kg 10 minutes before TKR skin incision. In the control group, 0.4 mL of low-molecular-weight heparin calcium was injected subcutaneously 12 h after TKR as the first administration, followed by subcutaneous injection of 0.4 mL in the 1st day, for 2 weeks. In the treatment group, 10 mg of rivaroxaban was orally administered 12 hours after TKR as the first administration, and then 10 mg/d in the 1st day, for 2 weeks. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), coagulation time (R), clotting time (K) K, clot formation rate (α angle), maximum amplitude (MA), whole blood high shear viscosity, plasma viscosity, hematocrit of the two groups of patients were compared. The postoperative complications of the two groups were counted.Results There was no significant difference in PT, APTT and FIB between the two groups before and after treatment (P > 0.05). There was no significant difference in R, K, α Angle and MA between the two groups before and after treatment (P > 0.05). There were no significant differences in total blood loss, recessive blood loss and dominant blood loss between 2 groups (P > 0.05). There were no significant differences in whole blood high tangential viscosity, plasma viscosity and erythrocyte ratio tolerance between the two groups before and after treatment (P > 0.05). The total complication rate of the study group was higher than that of the control group (P < 0.05).Conclusion Rivaroxaban and low-molecular-weight heparin calcium combined with tranexamic acid have similar hemostatic effects in patients with initial TKR, but low-molecular-weight heparin calcium combined with tranexamic acid is more safe.