[1]庞永华,陈伟南,许科峰,等.TKA应用氨甲环酸后序贯应用两种新型口服抗凝药预防VTE的疗效对比[J].医学信息,2022,35(09):100-103.[doi:10.3969/j.issn.1006-1959.2022.09.025]
　PANG Yong-hua,CHEN Wei-nan,XU Ke-feng,et al.Comparison of Efficacy of Sequential Application of Two New Oral Anticoagulants in the Prevention of VTE After Application of Tranexamic Acid in TKA[J].Medical Information,2022,35(09):100-103.[doi:10.3969/j.issn.1006-1959.2022.09.025]
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TKA应用氨甲环酸后序贯应用两种新型口服抗凝药预防VTE的疗效对比()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
35卷
期数:
2022年09期
页码:
100-103
栏目:
论著
出版日期:
2022-05-01

文章信息/Info

Title:
Comparison of Efficacy of Sequential Application of Two New Oral Anticoagulants in the Prevention of VTE After Application of Tranexamic Acid in TKA
文章编号:
1006-1959（2022）09-0100-04
作者:
庞永华; 陈伟南; 许科峰; 等
（1.安徽医科大学无锡临床学院骨科，江苏 无锡 214044；2.联勤保障部队第九〇四医院骨科，江苏 无锡 215006）
Author(s):
PANG Yong-hua; CHEN Wei-nan; XU Ke-feng; et al.
(1.Department of Orthopaedics,Wuxi Clinical College of Anhui Medical University,Wuxi 214044,Jiangsu,China;2.Department of Orthopedics,904th Hospital of PLA Joint Logistics Support Force,Wuxi 215006,Jiangsu,China)
关键词:
全膝关节置换; 静脉血栓栓塞; 氨甲环酸; 阿哌沙班; 利伐沙班
Keywords:
Total knee arthroplasty; Venous thromboembolism; Tranexamic acid; Apixaban; Rivaroxaban
分类号:
R687.4
DOI:
10.3969/j.issn.1006-1959.2022.09.025
文献标志码:
A
摘要:
目的 探讨全膝关节置换术（TKA）局部及静脉联合应用氨甲环酸后序贯阿哌沙班与利伐沙班，预防静脉血栓栓塞的有效性及安全性对比。方法 收集2019年1月-2021年1月解放军联勤保障部队第九〇四医院骨科行膝关节置换术的100例患者的临床资料。按术中联合应用氨甲环酸后序贯抗凝药物的不同分为A组与B组，各50例。A组使用阿哌沙班，B组使用利伐沙班。比较两组术后引流量、总出血量、输血比例、相关出血事件发生率、VTE发生率和术后1、3和7 d凝血功能指标（PT和APTT）变化。结果 两组术后引流量、总失血量、输血比例比较，差异无统计学意义（P＞0.05）；A组发现肌间静脉血栓3例，B组发现2例，差异无统计学意义（P＞0.05）；A组发生临床相关非大出血事件2例，B组中发现3例，差异无统计学意义（P＞0.05）；两组术后1、3和7 d 的PT和APTT值均较术前延长，且在正常范围，组间比较，差异无统计学意义（P＞0.05）；两组住院期间均未发现大出血事件、症状性DVT及PE疑似病例，且术后1及3个月随访也未发现VTE和大出血事件。结论 对行初次单侧全膝关节置换的患者，围手术期静脉及局部联合应用氨甲环酸后序贯阿哌沙班和利伐沙班预防静脉血栓栓塞均具有良好效果及较高安全性。
Abstract:
Objective To compare the efficacy and safety of sequential apixaban and rivaroxaban in preventing venous thromboembolism after local and intravenous application of tranexamic acid in total knee arthroplasty.Methods The clinical data of 100 patients undergoing knee arthroplasty in Department of Orthopedics, 904th Hospital of PLA Joint Logistics Support Force from January 2019 to January 2021 were collected. The patients were divided into group A and group B according to the different sequential anticoagulant drugs after combined application of tranexamic acid, with 50 cases in each group. Group A was treated with apixaban, and group B was treated with rivaroxaban. The postoperative drainage volume, total bleeding volume, proportion of blood transfusion, incidence of related bleeding events, incidence of VTE, and changes of coagulation function indexes ( PT and APTT ) at 1, 3 and 7 days after operation were compared between the two groups.Results There was no significant difference in postoperative drainage volume, total blood loss and blood transfusion ratio between the two groups (P>0.05). There were 3 cases of intermuscular venous thrombosis in group A and 2 cases in group B, and the difference was not statistically significant (P>0.05). There were 2 cases of clinical related non-hemorrhage events in group A and 3 cases in group B, the difference was not statistically significant (P>0.05). The PT and APTT values at 1, 3 and 7 d after operation in the two groups were longer than those before operation and in the normal range, the difference was not statistically significant in the normal range (P>0.05). No massive hemorrhage, symptomatic DVT and PE suspected cases were found during hospitalization, and no VTE and massive hemorrhage were found during 1 and 3 months follow-up.Conclusion For patients undergoing primary unilateral total knee arthroplasty, sequential apixaban and rivaroxaban after intravenous and local application of tranexamic acid in perioperative period have good effect and high safety in preventing venous thromboembolism.

参考文献/References:

[1]边焱焱,程开源,常晓,等.2011至2019年中国人工髋膝关节置换手术量的初步统计与分析[J].中华骨科杂志,2020,40(21):1453-1460.[2]王晓猛,牛映祯,纪刚,等.《中国骨科大手术静脉血栓栓塞症预防指南》的解读[J].中华骨科杂志,2017,37(10):636-640.[3]Karampinas PK,Megaloikonomos PD,Lampropoulou-Adamidou K,et al.Similar Thromboprophylaxis with Rivaroxaban and Low Molecular Weight Heparin but Fewer Hemorrhagic Complications with Combined Intra-Articular and Intravenous Tranexamic Acid in Total Knee Arthroplasty[J].Eur J Orthop Surg Traumatol,2019,29(2):455-460. [4]Le G,Yang C,Zhang M,et al.Efficacy and safety of aspirin and rivaroxaban for venous thromboembolism prophylaxis after total hip or knee arthroplasty: A protocol for meta-analysis[J].Medicine (Baltimore),2020,99(49):e23055.[5]Papadopoulos DV,Kostas-Agnantis I,Gkiatas I,et al.The Role of New Oral Anticoagulants in Orthopaedics: An Update of Recent Evidence[J].Eur J Orthop Surg Traumatol,2017,27(5):573-582.[6]Wu Y,Lu X,Ma Y,et al.Efficacy and safety of limb position on blood loss and range of motion after total knee arthroplasty without tourniquet: A randomized clinical trial[J].Int J Surg,2018,60:182-187.[7]Hui S,Xu D,Ren Z,et al.Can tranexamic acid conserve blood and save operative time in spinal surgeries? A meta-analysis[J].Spine J,2018,18(8):1325-1337.[8]Bookstaver DA,Sparks K,Pybus BS,et al.Comparison of Anti-Xa Activity in Patients Receiving Apixaban or Rivaroxaban[J].Ann Pharmacother,2018,52(3):251-256.[9]胡旭栋,周宗科,裴福兴,等.全膝关节置换术应用氨甲环酸后序贯应用阿哌沙班预防静脉血栓栓塞症的有效性和安全性[J].中华骨与关节外科杂志,2015,8(5):385-389.[10]Xie J,Ma J,Huang Q,et al.Comparison of Enoxaparin and Rivaroxaban in Balance of Anti-Fibrinolysis and Anticoagulation Following Primary Total Knee Replacement: A Pilot Study[J].Med Sci Monit,2017,23:704-711.[11]Nadler SB,Hidalgo JH,Bloch T.Prediction of blood volume in normal human adults[J].Surgery,1962,51(2):224-232.[12]Gross JB.Estimating Allowable Blood Loss: Corrected for Dilution[J].Anesthesiology,1983,58(3):277-280.[13]Bahit MC,Lopes RD,Wojdyla DM,et al.Non-major bleeding with apixaban versus warfarin in patients with atrial fibrillation[J].Heart,2017,103(8):623-628.[14]Weycker D,Li X,Wygant GD,et al.Effectiveness and Safety of Apixaban versus Warfarin as Outpatient Treatment of Venous Thromboembolism in U.S. Clinical Practice[J].Thromb Haemost,2018,118(11):1951-1961.[15]Gomez D,Razmjou H,Donovan A,et al.A Phase IV Study of Thromboembolic and Bleeding Events Following Hip and Knee Arthroplasty Using Oral Factor Xa Inhibitor[J].J Arthroplasty,2017,32(3):958-964.[16]Fatima N,Barra ME,Roberts RJ,et al.Advances in Surgical Hemostasis: A Comprehensive Review and Meta-Analysis On Topical Tranexamic Acid in Spinal Deformity Surgery[J].Neurosurg Rev,2021,44(1):163-175.[17]Jeon YS,Park JS,Kim MK.Optimal Release Timing of Temporary Drain Clamping After Total Knee Arthroplasty[J].J Orthop Surg Res,2017,12(1):47.[18]Zhang Y,Zhang JW,Wang BH.Efficacy of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty:A meta-analysis[J].Medicine (Baltimore),2017,96(26):e7363.[19]Xia ZN,Zhou Q,Zhu W,et al.Low Molecular Weight Heparin for the Prevention of Deep Venous Thrombosis After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis[J].Int J Surg,2018,54(Pt A):265-275.[20]Dawwas GK,Brown J,Dietrich E,et al.Effectiveness and Safety of Apixaban Versus Rivaroxaban for Prevention of Recurrent Venous Thromboembolism and Adverse Bleeding Events in Patients with Venous Thromboembolism: A Retrospective Population-Based Cohort Analysis[J].Lancet Haematol,2019,6(1):e20-e28.[21]Venker BT,Ganti BR,Lin H,et al.Safety and Efficacy of New Anticoagulants for the Prevention of Venous Thromboembolism After Hip and Knee Arthroplasty:A Meta-Analysis[J].J Arthroplasty,2017,32(2):645-652.

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更新日期/Last Update: 1900-01-01