抗纤溶序贯抗凝平衡预防初次THA术后VTE的单中心大样本连续病例观察性研究
发布时间：2018-10-22 19:39
【摘要】：[目的]单中心大样本连续病例观察性研究旨在探讨初次全髋关节置换术中使用氨甲环酸对术后静脉血栓栓塞症的影响及THA围手术期抗纤溶与抗凝平衡的初步临床疗效。[方法]基于国家卫生行业数据库平台,前瞻性收集本中心行初次单侧全髋关节置换术患者的基本资料,纳入患者围手术期静脉或静脉联合局部使用氨甲环酸抗纤溶,术后6 h开始序贯使用低分子肝素或利伐沙班抗凝。主要观察指标为血栓发生情况及术后30 d全因死亡人数;次要指标为输血率;同时根据氨甲环酸使用方式进行亚组分析。[结果]2012~2014年,共纳入本中心初次单侧全髋关节置换术患者3 043例。共有199例(6.54%)发生术后血栓栓塞事件,其中肌间静脉血栓183例(6.01%),非症状性深静脉血栓16例(0.53%),无发生症状性深静脉血栓、肺栓塞及死亡患者;186例(6.1%)患者接受输血。亚组分析结果提示静脉联合局部使用氨甲环酸较单纯静脉使用术后输血率更低(5.4%Vs 7.2%),差异有统计学意义(P=0.039);深静脉血栓的发生率并没有增加(0.6%Vs 0.4%,P=0.578)。[结论]THA围手术期使用TXA抗纤溶后,序贯抗凝维持两者平衡,可安全的减少围手术期输血率。
[Abstract]:[objective] to investigate the effect of carbamoic acid on venous thromboembolism after primary total hip arthroplasty and the preliminary clinical effect of antifibrinolysis and anticoagulant balance in THA perioperative period. [methods] based on the National Health Industry Database platform, the basic data of patients undergoing primary unilateral total hip arthroplasty in our center were collected prospectively, and the patients were included in the perioperative period of local use of carbamoic acid and fibrinolysis. Low molecular weight heparin (LMWH) or rivastaban were used in sequential anticoagulant therapy 6 hours after operation. The main outcome measures were the incidence of thrombus and the total death toll 30 days after operation, the secondary index was blood transfusion rate, and the subgroup analysis was carried out according to the use of carbamoic acid. [results] from 2012 to 2014, 3 043 patients with primary unilateral total hip arthroplasty were enrolled. There were 199 cases (6.54%) of postoperative thromboembolism, including 183 cases (6.01%) of intermuscular venous thrombosis and 16 cases (0.53%) of non-symptomatic deep venous thrombosis, no symptomatic deep venous thrombosis, pulmonary embolism and death, 186 cases (6.1%) received blood transfusion. The results of subgroup analysis showed that the blood transfusion rate was lower (5.4%Vs 7.2%) and the incidence of deep venous thrombosis was not increased (0.6%Vs 0.4g / P0. 578). [conclusion] after anti fibrinolysis of TXA in THA perioperative period, sequential anticoagulant and anticoagulant balance can be maintained and blood transfusion rate can be reduced safely during perioperative period.
【作者单位】： 四川大学华西医院骨科;
【基金】：卫生部2013年度卫生行业科研专项项目(编号:201302007)
【分类号】：R687.4
，
本文编号：2288113
[Abstract]:[objective] to investigate the effect of carbamoic acid on venous thromboembolism after primary total hip arthroplasty and the preliminary clinical effect of antifibrinolysis and anticoagulant balance in THA perioperative period. [methods] based on the National Health Industry Database platform, the basic data of patients undergoing primary unilateral total hip arthroplasty in our center were collected prospectively, and the patients were included in the perioperative period of local use of carbamoic acid and fibrinolysis. Low molecular weight heparin (LMWH) or rivastaban were used in sequential anticoagulant therapy 6 hours after operation. The main outcome measures were the incidence of thrombus and the total death toll 30 days after operation, the secondary index was blood transfusion rate, and the subgroup analysis was carried out according to the use of carbamoic acid. [results] from 2012 to 2014, 3 043 patients with primary unilateral total hip arthroplasty were enrolled. There were 199 cases (6.54%) of postoperative thromboembolism, including 183 cases (6.01%) of intermuscular venous thrombosis and 16 cases (0.53%) of non-symptomatic deep venous thrombosis, no symptomatic deep venous thrombosis, pulmonary embolism and death, 186 cases (6.1%) received blood transfusion. The results of subgroup analysis showed that the blood transfusion rate was lower (5.4%Vs 7.2%) and the incidence of deep venous thrombosis was not increased (0.6%Vs 0.4g / P0. 578). [conclusion] after anti fibrinolysis of TXA in THA perioperative period, sequential anticoagulant and anticoagulant balance can be maintained and blood transfusion rate can be reduced safely during perioperative period.
【作者单位】： 四川大学华西医院骨科;
【基金】：卫生部2013年度卫生行业科研专项项目(编号:201302007)
【分类号】：R687.4
，
本文编号：2288113
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