Weale A E, Warwick D J, Durant N, Prothero D
Taunton and Somerset Hospital, Musgrove Park.
Ann R Coll Surg Engl. 1995 Jan;77(1):35-7.
The benefits of parenteral non-steroidal analgesic drugs and low molecular weight heparin anticoagulants have been shown before, but there is concern that the use of these agents in combination may potentiate haemorrhagic side-effects because of simultaneous inhibition of the clotting cascade and platelet mechanisms of haemostasis. In a prospective controlled trial, 60 patients undergoing total hip replacement were randomised into two groups. Those in one group received intramuscular ketorolac and those in the other group opioid analgesia. All patients received enoxaparin subcutaneously, once daily. There were 34 patients in the NSAID group and 26 in the opiate group. There were no significant differences between the two groups for intraoperative blood loss, postoperative drainage, transfusion requirements, bruising, wound oozing and leg swelling. From this study it would appear that there is a low risk of significant haemostatic potentiation associated with concurrent use of low molecular weight heparin and a modest dose of ketorolac tromethamine.
肠胃外非甾体类镇痛药和低分子量肝素抗凝剂的益处此前已有显示，但有人担心联合使用这些药物可能会增强出血副作用，因为它们会同时抑制凝血级联反应和血小板止血机制。在一项前瞻性对照试验中，60例行全髋关节置换术的患者被随机分为两组。一组接受肌肉注射酮咯酸，另一组接受阿片类镇痛。所有患者均皮下注射依诺肝素，每日一次。非甾体抗炎药组有34例患者，阿片类药物组有26例患者。两组在术中失血、术后引流、输血需求、瘀斑、伤口渗血和腿部肿胀方面无显著差异。从这项研究来看，同时使用低分子量肝素和适量剂量的酮咯酸氨丁三醇导致显著止血增强的风险较低。
