• 濟(jì)寧醫(yī)學(xué)院附屬醫(yī)院骨關(guān)節(jié)科（山東濟(jì)寧，272029）;

目的 通過(guò)與低分子肝素鈣比較，分析利伐沙班對(duì)初次行人工全膝關(guān)節(jié)置換術(shù)（total knee arthroplasty，TKA）術(shù)后隱性失血及輸血率的影響。 方法回顧分析2009年 12 月－2011年 1 月初次行TKA的 90例單膝骨關(guān)節(jié)炎患者臨床資料，術(shù)后12 h 開始對(duì)其中45例給予利伐沙班10 mg/d （試驗(yàn)組），另外 45 例給予低分子肝素鈣注射液0.4 mL/ d（對(duì)照組），共14 d。兩組性別、年齡、病程及關(guān)節(jié)活動(dòng)度等一般資料比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），具有可比性。 結(jié)果試驗(yàn)組手術(shù)時(shí)間為（92.32 ± 23.13）min，對(duì)照組為（89.81 ± 18.65）min，差異無(wú)統(tǒng)計(jì)學(xué)意義（t=0.26，P=0.79）。試驗(yàn)組和對(duì)照組隱性失血量分別為 （40.18 ± 14.85）、（34.04 ± 12.96）g/L，差異有統(tǒng)計(jì)學(xué)意義（t=2.09，P=0.00）；顯性失血量分別為 （30.60 ± 2.89）、（28.85 ± 8.10）g/L，差異無(wú)統(tǒng)計(jì)學(xué)意義 （t=1.37，P=0.17）。術(shù)后試驗(yàn)組輸血率為73.33%（33/45）， 對(duì)照組為55.56%（25/45）， 差異無(wú)統(tǒng)計(jì)學(xué)意義 （χ2=3.10，P=0.08）。試驗(yàn)組和對(duì)照組術(shù)后輸血量分別為 （1.44 ± 1.09）、（1.06 ± 1.17） U，差異無(wú)統(tǒng)計(jì)學(xué)意義 （t=1.58， P=0.11）。術(shù)后試驗(yàn)組1例發(fā)生應(yīng)激性潰瘍；對(duì)照組1例出現(xiàn)癥狀性下肢深靜脈血栓形成、4 例出現(xiàn)無(wú)癥狀性肌間靜脈血栓形成，試驗(yàn)組無(wú)下肢深、淺靜脈血栓形成發(fā)生。 結(jié)論初次行 TKA 術(shù)后應(yīng)用利伐沙班會(huì)影響患者隱性失血，增加術(shù)后失血量及輸血率，需在抗凝治療同時(shí)密切關(guān)注血紅蛋白變化，及時(shí)補(bǔ)充血容量。

引用本文： 王國(guó)棟,張?jiān)?趙曉偉,張玉革,王雷,孔穎. 利伐沙班對(duì)初次行人工全膝關(guān)節(jié)置換術(shù)后隱性失血及輸血率的影響. 中國(guó)修復(fù)重建外科雜志, 2012, 26(11): 1306-1309. doi: 復(fù)制

1. Bozic KJ, Vail TP, Pekow PS, et al. Does aspirin have a role in venous thromboembolism prophylaxis in total knee arthroplasty patients? J Arthroplasty, 2010, 25(7): 1053-1060.
2. Lotke PA, Lonner JH. The benefit of aspirin chemoprophylaxis for thromboembolism after total knee arthroplasty. Clin Orthop Relat Res, 2006, (452): 175-180.
3. Bell TH, Berta D, Ralley F, et al. Factors affecting perioperative blood loss and transfusion rates in primary total joint arthroplasty: a prospective analysis of 1 642 patients. Can J Surg, 2009, 52(4): 295-301.
4. Schnurr C, Csécsei G, Eysel P, et al. The effect of computer navigation on blood loss and transfusion rate in TKA. Orthopedics, 2010, 33(7): 474.
5. Muñoz M, García-Vallejo JJ, Ruiz MD, et al. Transfusion of post-operative shed blood: laboratory characteristics and clinical utility. Eur Spine J, 2004, 13 Suppl 1: S107-S113.
6. Alban S. From heparins to factor Xa inhibitors and beyond. Eur J Clin Invest, 2005, 35 Suppl 1: 12-20.
7. Ryttberg L, Diamantopoulos A, Forster F, et al. Cost-effectiveness of rivaroxaban versus heparins for prevention of venous thromboembolism after total hip or knee surgery in Sweden. Expert Rev Pharmacoecon Outcomes Res, 2011, 11(5): 601-615.
8. Alves C, Batel-Marques F, Macedo AF. Apixaban and rivaroxaban safety after hip and knee arthroplasty: a meta-analysis. J Cardiovasc Pharmacol Ther, 2012, 17(3): 266-276.
9. Fassiadis N. Rivaroxaban: direct factor Xa inhibition to treat acute deep vein thrombosis. Br J Hosp Med (Lond), 2011, 72(9): 486.
10. Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med, 2008, 358(26): 2765-2775.
11. Kakkar AK, Brenner B, Dahl OE, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet, 2008, 372(9632): 31-39.
12. Lassen MR, Ageno W, Borris LC, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med, 2008, 358(26): 2776-2786.
13. Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet, 2009, 373(9676): 1673-1680.
14. Deeks ED. Apixaban: a review of its use in the prevention of venous thromboembolism after knee or hip replacement surgery. Drugs, 2012, 72(9): 1271-1291.
15. Witt DM. Rivaroxaban and usual care had similar rates of recurrent VTE and bleeding in symptomatic PE. Ann Intern Med, 2012, 157(4): JC2-6.
16. Beyer-Westendorf J, Lützner J, Donath L, et al. Efficacy and safety of rivaroxaban or fondaparinux thromboprophylaxis in major orthopaedic surgery-findings from the ortho-tep registry. J Thromb Haemost, 2012, 10(10): 2045-2052.
17. Eriksson BI, Borris LC, Dahl OE, et al. Oral, direct factor Xa inhibition with BAY 59-7939 for the prevention of venous thromboembolism after total hip replacement. J Thromb Haemost, 2006, 4(1): 121-128.
18. Horloeker TT. Low molecular weight heparin and neuraxial anesthesia. Thromb Res, 2001, 101(1): V141-154.
19. 馬衛(wèi)華, 張樹棟, 慕宏杰, 等. 低分子肝素使用時(shí)機(jī)對(duì)關(guān)節(jié)置換手術(shù)失血量和DVT發(fā)生率的影響. 中華骨科雜志, 2008, 28(10): 833-837.
  1. 1. Bozic KJ, Vail TP, Pekow PS, et al. Does aspirin have a role in venous thromboembolism prophylaxis in total knee arthroplasty patients? J Arthroplasty, 2010, 25(7): 1053-1060.
  2. 2. Lotke PA, Lonner JH. The benefit of aspirin chemoprophylaxis for thromboembolism after total knee arthroplasty. Clin Orthop Relat Res, 2006, (452): 175-180.
  3. 3. Bell TH, Berta D, Ralley F, et al. Factors affecting perioperative blood loss and transfusion rates in primary total joint arthroplasty: a prospective analysis of 1 642 patients. Can J Surg, 2009, 52(4): 295-301.
  4. 4. Schnurr C, Csécsei G, Eysel P, et al. The effect of computer navigation on blood loss and transfusion rate in TKA. Orthopedics, 2010, 33(7): 474.
  5. 5. Muñoz M, García-Vallejo JJ, Ruiz MD, et al. Transfusion of post-operative shed blood: laboratory characteristics and clinical utility. Eur Spine J, 2004, 13 Suppl 1: S107-S113.
  6. 6. Alban S. From heparins to factor Xa inhibitors and beyond. Eur J Clin Invest, 2005, 35 Suppl 1: 12-20.
  7. 7. Ryttberg L, Diamantopoulos A, Forster F, et al. Cost-effectiveness of rivaroxaban versus heparins for prevention of venous thromboembolism after total hip or knee surgery in Sweden. Expert Rev Pharmacoecon Outcomes Res, 2011, 11(5): 601-615.
  8. 8. Alves C, Batel-Marques F, Macedo AF. Apixaban and rivaroxaban safety after hip and knee arthroplasty: a meta-analysis. J Cardiovasc Pharmacol Ther, 2012, 17(3): 266-276.
  9. 9. Fassiadis N. Rivaroxaban: direct factor Xa inhibition to treat acute deep vein thrombosis. Br J Hosp Med (Lond), 2011, 72(9): 486.
  10. 10. Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med, 2008, 358(26): 2765-2775.
  11. 11. Kakkar AK, Brenner B, Dahl OE, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet, 2008, 372(9632): 31-39.
  12. 12. Lassen MR, Ageno W, Borris LC, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med, 2008, 358(26): 2776-2786.
  13. 13. Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet, 2009, 373(9676): 1673-1680.
  14. 14. Deeks ED. Apixaban: a review of its use in the prevention of venous thromboembolism after knee or hip replacement surgery. Drugs, 2012, 72(9): 1271-1291.
  15. 15. Witt DM. Rivaroxaban and usual care had similar rates of recurrent VTE and bleeding in symptomatic PE. Ann Intern Med, 2012, 157(4): JC2-6.
  16. 16. Beyer-Westendorf J, Lützner J, Donath L, et al. Efficacy and safety of rivaroxaban or fondaparinux thromboprophylaxis in major orthopaedic surgery-findings from the ortho-tep registry. J Thromb Haemost, 2012, 10(10): 2045-2052.
  17. 17. Eriksson BI, Borris LC, Dahl OE, et al. Oral, direct factor Xa inhibition with BAY 59-7939 for the prevention of venous thromboembolism after total hip replacement. J Thromb Haemost, 2006, 4(1): 121-128.
  18. 18. Horloeker TT. Low molecular weight heparin and neuraxial anesthesia. Thromb Res, 2001, 101(1): V141-154.
  19. 19. 馬衛(wèi)華, 張樹棟, 慕宏杰, 等. 低分子肝素使用時(shí)機(jī)對(duì)關(guān)節(jié)置換手術(shù)失血量和DVT發(fā)生率的影響. 中華骨科雜志, 2008, 28(10): 833-837.