Résumé
OBJECTIVE:To observe the effects and safety of different treatment courses of rivaroxaban in prevention and treatment of deep venous thrombosis(DVT)after total hip replacement. METHODS:The clinical data of 127 patients under-went selective total hip replacement in our hospital during Dec. 2014-Dec. 2015 were selected and analyzed retrospectively. They were divided into group A [83 cases,subdivided into group A1(40 cases)and A2(43 cases)by treatment course] and group B (44 cases) according to anticoagulant duration. Group A was given Rivaroxaban tablet 10 mg,po,qd,6-8 h after surgery;the treatment course of group A1 was 5 weeks(35 d)while that of group A2 was 2 weeks(14 d). Group B was giv-en Enoxaparin sodium injection 5000 AxaIU,sc,qd,12d before surgery;and then given Enoxaparin sodium injection 5000 AxaIU,sc,qd,after surgery;the treatment course lasted for 2 weeks. The incidence of DVT were compared among 3 groups as well as thrombin time(TT),activated partial thromboplastin time(APTT),hemoglobin(Hb)content,whole blood viscos-ity,plasma viscosity,platelet count and anticoagulant safety 3 days before surgery and after treatment. RESULTS:The inci-dence of DVT in group A1 was 0,which was significantly lower than that in group A2 (9.30%) and group B (11.36%), with statistical significance(P0.05). Wheth-er 3 d before surgery or after treatment,there was no statistical significance in PT,APTT,Hb content,whole blood viscosi-ty,plasma viscosity and platelet count among 3 groups (P>0.05). No major bleeding events or pulmonary embolism was found in 3 groups. The incidence of mild bleeding events in group A was 5.00%,which was slightly higher than that in group A2 (2.33%) and group B (2.27%),without statistical significance (P>0.05);there was no statistical significance between group A2 and group B(P>0.05). CONCLUSIONS:Rivaroxiban long-term anticoagulation after total hip replacement has no significant effect on coagulation function and platelet,not only decrease the incidence of DVT,but also will not increase no bleeding with good safety.
Résumé
Objective To discuss the curative effect and specificity of interventional therapy for deep venous thrombosis (DVT) of lower limb in burned patients.Methods The clinical data of 13 patients with lower limb DVT after burn,including 7 males and 6 females with a median age of 46.1 years (37-67 years),were retrospectively analyzed.The causes of burn included flame burn (n=9),electric injury (n=2) and hydrothermal bum (n=2).The burned area was 1％-88％ of the total body surface,with a mean of (37.08± 30.60) ％.Lower limb DVT complicated by lower limb bum was observed in 11 patients,among them bum of both lower limbs was seen in 8 patients.Lower limb DVT associated with inhalation injury was found in 5 patients.Clinically,lower limb DVT was usually detected in 13-72 days after burn,with a mean of (38.69± 16.83) days.Interventional treatment was carried out in all 13 patients,and the curative effect was assessed.Results Technical success of interventional treatment was obtained in all 13 patients.Both inferior vena cava filter placement via right internal jugular vein approach (n=3) or via unaffected-side femoral vein approach (n=10) and anticoagulant therapy were conducted.Catheter-directed thrombolysis was employed in 7 patients,intravenous thrombolysis was adopted in 4 patients,and no thrombolysis therapy was used in 2 patients.No pulmonary embolism occurred.The curative effect rate of interventional treatment was 84.6％(11/ 13).Conclusion For the treatment of lower limb DVT after burn,interventional therapy is safe and reliable,but the selection of puncture site and the use or not use of indwelling catheter for thrombolysis should be carefully taken into consideration.