Sasaki Satoshi, Miyakoshi Naohisa, Matsuura Hiroshi, Saito Hidetomo, Nakanishi Toru, Kudo Yumiko, Fujiya Tomiko, Shimada Yoichi
Department of Orthopedic Surgery, Yuri-Kumiai General Hospital, 38 Yago Kawaguchi, Yurihonjo, 015-8511, Japan.
J Orthop Sci. 2011 Jan;16(1):64-70. doi: 10.1007/s00776-010-0011-5. Epub 2011 Feb 4.
Venous thromboembolism (VTE) is a common complication in hip fracture surgery (HFS). Fondaparinux (FPX) and enoxaparin (ENO) have been reported to decrease the incidence of VTE after HFS. The purpose of this study was to determine the efficacies of FPX and ENO and the superior agent for preventing VTE after HFS by performing a prospective study in a Japanese population.
Eighty-four Japanese patients who underwent HFS were assigned to either FPX (received FPX 1.5 or 2.5 mg/day for 14 days), ENO (received ENO 2000 IU once or twice/day for 14 days), or untreated control (CTRL) groups in order of surgery. All patients underwent ultrasonography of the lower extremities 7 days after HFS to evaluate the extent of deep-vein thrombosis. Incidence of VTE, D-dimer values measured at admission and 7 and 14 days after HFS, and the side effects of FPX and ENO were compared.
The incidence of VTE and the D-dimer values on days 7 and 14 in the FPX group were significantly lower than the corresponding levels in the CTRL group (P < 0.05). The D-dimer values on day 7 in the ENO group were significantly lower than those in the CTRL group, whereas the incidence of VTE was not significantly different. Side effects were observed in 3 cases: major bleeding occurred in 2 patients who received FPX, whereas minor bleeding occurred in 1 patient who received ENO.
We concluded that FPX was the superior agent for preventing VTE after HFS. However, patients receiving FPX should be monitored for bleeding.
静脉血栓栓塞症（VTE）是髋部骨折手术（HFS）中常见的并发症。据报道，磺达肝癸钠（FPX）和依诺肝素（ENO）可降低HFS后VTE的发生率。本研究的目的是通过在日本人群中进行前瞻性研究，确定FPX和ENO预防HFS后VTE的疗效及更优药物。
84例接受HFS的日本患者按手术顺序被分为FPX组（接受FPX 1.5或2.5mg/天，共14天）、ENO组（接受ENO 2000IU，每日1次或2次，共14天）或未治疗的对照组（CTRL组）。所有患者在HFS后7天接受下肢超声检查，以评估深静脉血栓形成的程度。比较VTE的发生率、HFS入院时及术后7天和14天测得的D - 二聚体值，以及FPX和ENO的副作用。
FPX组VTE的发生率以及术后7天和14天的D - 二聚体值均显著低于CTRL组（P < 0.05）。ENO组术后7天的D - 二聚体值显著低于CTRL组，而VTE的发生率无显著差异。观察到3例副作用：2例接受FPX的患者发生大出血，1例接受ENO的患者发生小出血。
我们得出结论，FPX是预防HFS后VTE的更优药物。然而，接受FPX治疗的患者应监测出血情况。
