Department of Othopedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chendu, 610041, People's Republic of China.
Department of Othopedics, The second People's Hospital of Jiu Long Po District, Chongqing, 400050, People's Republic of China.
Sci Rep. 2018 Jun 11;8(1):8847. doi: 10.1038/s41598-018-27243-1.
Our objective was to evaluate the efficacy and safety of natural hirudin and low molecular weight heparin (LMWH) in the prevention of perioperative deep venous thrombosis (DVT) in elderly patients with intertrochanteric fracture. From June 2014 to June 2017, 96 patients with intertrochanteric fractures were treated with proximal femoral nail antirotation (PFNA) were randomly divided into two groups. For DVT prevention, 45 patients were treated with oral natural hirudin and subcutaneous LMWH-calcium (test group) and 51 patients were treated with subcutaneous LMWH-calcium (control group). The mean intraoperative bleeding, wound drainage and incisional hematoma were higher in the test group, with no significant differences between the groups. There were significant differences in distal intramuscular venous thrombosis (P = 0.043). Both activated partial thromboplastin time (APTT), thrombin time (TT), and prothrombin time (PT) lengthened in both groups postoperatively, and there was a significant difference between the two groups two weeks postoperatively. D-dimer were significantly different and platelet count (PLT) did not differ between groups two weeks postoperatively. In elderly patients with unilateral intertrochanteric fracture after PFNA on anticoagulant therapy, the combination of natural hirudin and LMWH was more effective than that of LMWH-calcium alone, with no significant difference with regard to safety.
我们的目的是评估天然水蛭素和低分子肝素（LMWH）在预防老年股骨转子间骨折患者围手术期深静脉血栓形成（DVT）中的疗效和安全性。从 2014 年 6 月至 2017 年 6 月，96 例股骨转子间骨折患者采用股骨近端防旋髓内钉（PFNA）治疗，随机分为两组。为预防 DVT，45 例患者口服天然水蛭素和皮下低分子肝素钙（试验组），51 例患者皮下低分子肝素钙（对照组）。试验组术中出血量、伤口引流量和切口血肿较多，但两组间差异无统计学意义。远端肌间静脉血栓形成（P = 0.043）差异有统计学意义。两组术后活化部分凝血活酶时间（APTT）、凝血酶时间（TT）和凝血酶原时间（PT）均延长，术后两周两组间差异有统计学意义。术后两周两组间 D-二聚体差异有统计学意义，血小板计数（PLT）无差异。在单侧股骨转子间骨折患者接受 PFNA 抗凝治疗后，天然水蛭素联合 LMWH 比单独使用 LMWH 钙更有效，安全性方面无显著差异。
