Zhang Heng, Lin Jianhao, Li Hu, Guan Zhenpeng, Zhou Diange, Kou Bolong, Wei Wei
Research Center for Diagnosis & Treatment of Bone & Joint Diseases, Peking University People's Hospital, Beijing 100044, China.
Research Center for Diagnosis & Treatment of Bone & Joint Diseases, Peking University People's Hospital, Beijing 100044, China. Email:
Zhonghua Yi Xue Za Zhi. 2014 Feb 25;94(7):525-8.
To compare the effects of short-term and long-term thromboprophylaxis after total hip replacement on coagulation indicators in plasma sampled before and 1, 7 and 35 days post-operation.
A total of 40 patients scheduled for elective total hip replacement were randomly assigned into the short-term (n = 20) or long-term (n = 20) thromboprophylaxis groups on oral rivaroxaban 10 mg once daily for 7 or 35 days. The primary efficacy hemostatic variables included thrombin-antithrombin complexes (TAT), prothrombin fragment 1+2 (F1t2), D-dimer and fibrinogen (Fib) preoperatively and at Days 1, 7 and 35 postoperatively. And ultrasonography was performed on all patients preoperatively and at days 7 and 35 postoperatively to exclude deep vein thrombosis of lower extremities.
None of them had deep vein thrombosis (DVT) of lower extremities. Among them, TAT, F1+2, D-dimer and Fib post-operation were higher than those preoperative baseline values. TAT and D-dimer peaked at day 1 postoperatively while the peaks of F1+2 and Fib appeared at day 7 postoperatively. At Day 35 post-operation, the levels of TAT and F1+2 in the long-term thromboprophylaxis group were significantly lower than those of the short-term thromboprophylaxis group (P < 0.05).
The status of hypercoagulability may sustain at least 35 days after total hip replacement. Though not completely eliminated, it can still be reduced by prolonged thromboprophylaxis. However, according to ultrasonography, the effects of short-term and long-term thromboprophylaxis on the incidence rate of DVT remain to be further explored.
比较全髋关节置换术后短期和长期血栓预防对术前及术后1天、7天和35天采集的血浆凝血指标的影响。
将40例行择期全髋关节置换术的患者随机分为短期（n = 20）或长期（n = 20）血栓预防组，口服利伐沙班10 mg，每日1次，持续7天或35天。主要疗效止血变量包括术前及术后第1天、7天和35天的凝血酶 - 抗凝血酶复合物（TAT）、凝血酶原片段1 + 2（F1 + 2）、D - 二聚体和纤维蛋白原（Fib）。所有患者术前及术后第7天和35天行超声检查以排除下肢深静脉血栓形成。
所有患者均未发生下肢深静脉血栓形成（DVT）。其中，术后TAT、F1 + 2、D - 二聚体和Fib均高于术前基线值。TAT和D - 二聚体在术后第1天达到峰值，而F1 + 2和Fib的峰值出现在术后第7天。术后第35天，长期血栓预防组的TAT和F1 + 2水平显著低于短期血栓预防组（P < 0.05）。
全髋关节置换术后高凝状态可能至少持续35天。虽然不能完全消除，但延长血栓预防仍可降低其程度。然而，根据超声检查结果，短期和长期血栓预防对DVT发生率的影响仍有待进一步探讨。
