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目的探讨利伐沙班对预防老年膝关节原发性骨肿瘤术后静脉血栓栓塞(VTE)的临床疗效及其安全性。方法 81例膝关节骨肿瘤老年患者,按治疗不同分为试验组(利伐沙班+低分子量肝素)44例和对照组(低分子量肝素)37例,观察两组患者的深静脉血栓(DVT)发生率、非致死性肺栓塞(PE)及其全因死亡率,检测手术前后D-二聚体水平、血小板计数(PLT)及活化部分凝血活酶时间(APTT)水平,并观察术后引流、出血及其他不良事件发生情况。结果观察至术后28 d,两组DVT发生率差异显著(P<0.05);对照组有1例出现非致死性PE,但差异无统计学意义(P>0.05),且两组均无PE全因死亡发生;D-二聚体水平比较,试验组显著低于对照组(P<0.05),而PLT和APTT水平无差异(P>0.05)。同时,各组D-二聚体、PLT及APTT等3项指标,随时间的变化全部显著(P<0.05);两组患者的术后引流量、引流时间和出血事件发生率无差异,且不良事件发生情况相似(P>0.05)。结论利伐沙班可进一步有效降低接受膝关节骨肿瘤手术的老年患者术后相关VTE的发生。
Objective To investigate the clinical efficacy and safety of rivaroxaban in preventing postoperative venous thromboembolism (VTE) in elderly patients with primary osteoarthritis of the knee. Methods Eighty-one elderly patients with knee osteoarthritis of the knee were divided into experimental group (rivaroxaban + low molecular weight heparin) and control group (low molecular weight heparin) of 44 cases according to the different treatment. The deep vein thrombosis (DVT) ), Non-fatal pulmonary embolism (PE) and all-cause mortality, D-dimer level, platelet count (PLT) and active partial thromboplastin time (APTT) Drainage, bleeding and other adverse events. Results The incidence of DVT was significantly different between the two groups (P <0.05) 28 days after operation. One case of non-lethal PE was found in the control group, but the difference was not statistically significant (P> 0.05) All-cause death occurred. The levels of D-dimer in the experimental group were significantly lower than those in the control group (P <0.05), but there was no difference in the levels of PLT and APTT (P> 0.05). At the same time, the indexes of D-dimer, PLT and APTT in all groups changed significantly with time (P <0.05). There was no difference in postoperative drainage, drainage time and incidence of bleeding between the two groups The occurrence of adverse events was similar (P> 0.05). Conclusion Rivaroxaban can further reduce the incidence of postoperative VTE in elderly patients undergoing knee osteosarcoma surgery.