CAJ | 학술논문

背景：现中国临床上常用抗凝药物为利伐沙班，但有效预防静脉血栓栓塞性疾病的同时，围手术期出血性并发症发生率也明显增加。有研究表明阿司匹林对深静脉血栓形成和肺栓塞具有良好预防效果，但对于能否将其作为全膝关节置换后预防静脉血栓栓塞性疾病的常规用药至今存在争议。 　　目的：观察比较阿司匹林和利伐沙班预防全膝关节置换后下肢深静脉血栓形成的疗效和安全性。 　　方法：初次行单侧全膝关节置换的324例骨关节炎患者随机等分为3组，于置换后12 h，分别用利伐沙班，低分子肝素，阿司匹林干预治疗14 d。所有患者均随访4周。 　　结果与结论：与低分子肝素组相比，利伐沙班组深静脉血栓发生率降低(P<0.05)，隐性失血量及切口并发症率升高(P <0.05)。与低分子肝素相比，阿司匹林组深静脉血栓发生率、隐性失血量、切口并发症率、下肢肿胀率和皮下瘀斑率差异均无显著性意义(P >0.05)。结果证实，利伐沙班拥有较强抗凝效果，但并发症发生率高。阿司匹林与低分子肝素相比疗效和安全性均无差异。阿司匹林作为全膝关节置换后多模式抗凝治疗的一部分，安全有效。
배경：현중국림상상상용항응약물위리벌사반，단유효예방정맥혈전전새성질병적동시，위수술기출혈성병발증발생솔야명현증가。유연구표명아사필림대심정맥혈전형성화폐전새구유량호예방효과，단대우능부장기작위전슬관절치환후예방정맥혈전전새성질병적상규용약지금존재쟁의。 　　목적：관찰비교아사필림화리벌사반예방전슬관절치환후하지심정맥혈전형성적료효화안전성。 　　방법：초차행단측전슬관절치환적324례골관절염환자수궤등분위3조，우치환후12 h，분별용리벌사반，저분자간소，아사필림간예치료14 d。소유환자균수방4주。 　　결과여결론：여저분자간소조상비，리벌사반조심정맥혈전발생솔강저(P<0.05)，은성실혈량급절구병발증솔승고(P <0.05)。여저분자간소상비，아사필림조심정맥혈전발생솔、은성실혈량、절구병발증솔、하지종창솔화피하어반솔차이균무현저성의의(P >0.05)。결과증실，리벌사반옹유교강항응효과，단병발증발생솔고。아사필림여저분자간소상비료효화안전성균무차이。아사필림작위전슬관절치환후다모식항응치료적일부분，안전유효。
BACKGROUND:To date, rivaroxaban has been a clinical y common anticoagulant in China;however, effective prophylaxis for venous thrombosis is associated with a markedly higher incidence of perioperative hemorrhagic complications. Although it has been reported that aspirin effectively prevents deep vein thrombosis and pulmonary embolism, the use of aspirin as a routine drug for venous thrombosis after total knee arthroplasty is stil controversial. OBJECTIVE:To compare the efficacy and safety of aspirin and rivaroxaban for prevention of deep vein thrombosis after total knee arthroplasty. METHODS:Total y 324 patients with osteoarthritis who underwent primary unilateral total knee arthroplasty were randomly divided into three groups. Twelve hours after the surgery, three groups were given aspirin, rivaroxaban and low-molecular-weight heparin respectively. Al three groups were treated for 14 days, and al of the patients were fol owed for 4 weeks. RESULTS AND CONCLUSION:Compared with the low-molecular-weight heparin group, the incidence of deep vein thrombosis was lower (P<0.05), but hidden blood loss and wound complications were more common (P<0.05) in the rivaroxaban group. There were no significant differences between the low-molecular-weight heparin group and aspirin group in the incidence of deep vein thrombosis, hidden blood loss, wound complications or incidences of lower limb swel ing and subcutaneous ecchymosis (P>0.05). The results confirmed that rivaroxaban has a positive anticoagulation effect but leads to increases in wound complications in patients;there are no differences in efficacy and safety between aspirin and low-molecular-weight heparin, so aspirin as part of a multimodal anticoagulation therapy after total knee arthroplasty has good clinical safety and efficacy.