| 李攀,刘耀波,吴世鹏,张宝鉴,孙润芳.两种抗凝剂预防老年髋部周围骨折患者围术期深静脉血栓形成的效果对比[J].实用中西医结合临床,2021,21(1):11-14 |
| 两种抗凝剂预防老年髋部周围骨折患者围术期深静脉血栓形成的效果对比 |
| Comparison of the Efficacy of Two Anticoagulants in the Prevention of Perioperative Deep Venous Thrombosis in Elderly Patients with Around Hip Fracture |
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| DOI： |
| 中文关键词: 老年髋部周围骨折 深静脉血栓形成 低分子量肝素钙 阿哌沙班 |
| 英文关键词: Elderly patients with around hip fracture DVT Low molecular weight heparin calcium Apixaban |
| 基金项目: |
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| 中文摘要: |
| 目的：对比低分子量肝素钙与阿哌沙班预防老年髋部周围骨折患者围术期深静脉血栓形成的有效性及安全性。方法：选取2018年3月~2020年3月于山西省中医院骨科行手术治疗的老年髋部周围骨折患者70例为研究对象，依据入院时间先后分为A组和B组，各35例。A组围术期皮下注射低分子量肝素钙预防血栓形成，B组围术期口服阿哌沙班预防血栓形成，两组术后持续抗凝35 d，随访3个月。比较两组手术指标；术前，术后第3、14天血红蛋白及凝血指标；随访3个月，统计深静脉血栓发生情况，出血事件发生情况。结果：两组手术相关指标比较，差异无统计学意义（P＞0.05）。两组术后第3、14天血红蛋白较术前下降，但组间比较差异无统计学意义（P＞0.05）。两组术后与术前比较，血小板计数、D-二聚体下降，活化部分凝血活酶时间、凝血酶原时间延长（均在正常范围内）；B组术后第3天、第14天D-二聚体低于A组，差异有统计学意义（P＜0.05）；两组术后第3天、第14天血小板计数、活化部分凝血活酶时间、凝血酶原时间比较，差异无统计学意义（P＞0.05）。两组术后随访3个月，均完成抗凝疗程，无脱落病例，两组均未发现肺栓塞疑似病例；B组深静脉血栓发生率低于A组（P＜0.05）；两组均无大出血患者，两组临床相关非大出血发生率比较，差异无统计学意义（P＞0.05）。结论：与采用低分子量肝素钙治疗相比，老年髋部周围骨折患者围手术期采用阿哌沙班预防深静脉血栓的疗效更佳，且不会增加出血风险。 |
| 英文摘要: |
| Objective: To compare the efficacy and safety of low molecular weight heparin calcium and apixaban in the prevention of perioperative deep venous thrombosis in elderly patients with around hip fracture. Methods: 70 Elderly patients with around hip fracture who underwent surgery in the department of orthopedics of Shanxi provincial hospital of traditional chinese medicine from March 2018 to March 2020 were selected as the research objects. According to the admission time, they were divided into group A and group B, 35 cases in each group. In group A, low molecular weight heparin calcium was injected subcutaneously to prevent thrombosis during perioperative period, while in group B, apixaban was taken orally to prevent thrombosis during perioperative period. Anticoagulation lasted for 35 days after operation in both groups, and the patients were followed up for 3 months. The operation indexes, hemoglobin (HGB) and coagulation indexes before operation, 3 days and 14 days after operation were compared between the two groups; the incidence of deep vein thrombosis and bleeding events were counted after 3 months of follow-up. Results: There was no significant difference in operation related indexes between the two groups (P＞0.05). HGB of the two groups decreased on the 3rd and 14th day after operation, but there was no significant difference between the two groups (P＞0.05). Compared with preoperative, PLT and D-dimer decreased, APTT and PT prolonged in the two groups (all within the normal range); DD in group B was lower than that in group A on the 3rd and 14th day after operation (P＜0.05); PLT, APTT and PT had no significant difference between the two groups on the 3rd and 14th day after operation (P＞0.05). The two groups were followed up for 3 months, all completed anticoagulant treatment, no shedding cases, no PE suspected cases were found in the two groups; the incidence of DVT in group B was lower than that in group A (P＜0.05); there was no massive hemorrhage in the two groups, and there was no significant difference in the incidence of clinically related non massive hemorrhage between the two groups (P＞0.05). Conclusion: Compared with the treatment of low molecular weight heparin calcium, the perioperative use of apixaban in the prevention of DVT in elderly patients with around hip fracture has better effect, and does not increase the risk of bleeding. |
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