利伐沙班在髂静脉支架术后血栓预防疗效
|
摘要
目的比较利伐沙班与华法林联合阿司匹林在髂静脉支架置入后预防血栓的效果差异,探讨利伐沙班在髂静脉支架内血栓预防的应用价值。方法回顾性分析郑州大学第一附属医院2014年1月—2016年6月期间就诊髂静脉受压综合征并置入支架患者61例,按治疗方式分为利伐沙班组(治疗组,37例)和华法林+阿司匹林组(对照组,24例)。两组术后均给予相同活血、消肿药物应用,穿弹力袜,住院期间均给予低分子肝素100 U·kg~(-1),q12h,预防血栓,出院后治疗组调整为利伐沙班20 mg,qd,对照组调整华法林达标(INR2-3)后出院给予华法林+阿司匹林应用,维持INR2-3。抗凝时长6个月,分别于术后1个月、3个月、6个月、1年、2年行彩超或静脉造影检查观察支架通畅情况。记录出血事件。结果 61例获得随访,随访2年对照组支架内血栓发生率16.21%,治疗组为12.50%(P>0.05)。对照组总出血率45.90%,治疗组为33.33%(P>0.05),对照组和治疗组小出血率分别为24.32%和33.33%(P>0.05),颅内等严重出血发生率分别为21.60%和0%(P<0.05)。合并急性深静脉血栓静脉临床严重程度(VCSS)评分比较,差异有统计学意义(P<0.05)。结论利伐沙班未增加总体出血的风险,能降低颅内等严重出血风险,未增加支架内血栓的发生率,且显著改善合并急性期血栓患者预后。
Objective To compare the efficacy of rivaroxaban and warfarin plus aspirin in preventing thrombosis after iliac vein stent implantation, and to explore the application value of rivaroxaban in preventing thrombosis in iliac vein stent. Methods A retrospective analysis of 61 patients with iliac vein compression syndrome and stent placement in the first affiliated hospital of Zhengzhou university from January 2014 to June 2016 was conducted.The patients was divided into rivaroxaban group(treatment group,n=37) and warfarin + aspirin group(control group,n=24).Both groups were given the same promoting blood circulation and ant swelling drugs, and wearing the stretch socks after surgery.During hospitalization, low molecular heparin(LWMH) in 100 U·kg~(-1),q12 h,was given to prevent thrombosis.After discharge, the treatment group was adjusted to rivaroxaban with 20 mg,qd,the control group was given warfarin plus aspirin after adjusting the standard of warfarin(INR2-3) and maintained this standard.The duration of anticoagulation was 6 months.The duration of anticoagulation was 6 months, and the stent patency was observed by ultrasound or venography in 1 month, 3 months, 6 months, 1 year and 2 years after surgery.Meanwhile, bleeding events were recorded. Results Sixty-one patients were followed up, and the incidence of thrombosis in stents in control group was 16.21% and that in treatment group was 12.50%(P>0.05).Total hemorrhage rate in control group and treatment group were 45.90%,33.33%(P>0.05), minor bleeding rate were 24.32%, 33.33%, respectively(P>0.05), severe bleeding were 21.60% and 0%, respectively(P<0.05).The differential has a statistical significance to the VCSS score of acute deep vein thrombosis(P<0.05). Conclusion Rivaroxaban did not increase the overall risk of bleeding, could reduce the risk of severe intracranial bleeding, did not increase the incidence of thrombus in the stent.The prognosis of patients with acute thrombosis was significant improved after use rivaroxaban.
Objective To compare the efficacy of rivaroxaban and warfarin plus aspirin in preventing thrombosis after iliac vein stent implantation, and to explore the application value of rivaroxaban in preventing thrombosis in iliac vein stent. Methods A retrospective analysis of 61 patients with iliac vein compression syndrome and stent placement in the first affiliated hospital of Zhengzhou university from January 2014 to June 2016 was conducted.The patients was divided into rivaroxaban group(treatment group,n=37) and warfarin + aspirin group(control group,n=24).Both groups were given the same promoting blood circulation and ant swelling drugs, and wearing the stretch socks after surgery.During hospitalization, low molecular heparin(LWMH) in 100 U·kg~(-1),q12 h,was given to prevent thrombosis.After discharge, the treatment group was adjusted to rivaroxaban with 20 mg,qd,the control group was given warfarin plus aspirin after adjusting the standard of warfarin(INR2-3) and maintained this standard.The duration of anticoagulation was 6 months.The duration of anticoagulation was 6 months, and the stent patency was observed by ultrasound or venography in 1 month, 3 months, 6 months, 1 year and 2 years after surgery.Meanwhile, bleeding events were recorded. Results Sixty-one patients were followed up, and the incidence of thrombosis in stents in control group was 16.21% and that in treatment group was 12.50%(P>0.05).Total hemorrhage rate in control group and treatment group were 45.90%,33.33%(P>0.05), minor bleeding rate were 24.32%, 33.33%, respectively(P>0.05), severe bleeding were 21.60% and 0%, respectively(P<0.05).The differential has a statistical significance to the VCSS score of acute deep vein thrombosis(P<0.05). Conclusion Rivaroxaban did not increase the overall risk of bleeding, could reduce the risk of severe intracranial bleeding, did not increase the incidence of thrombus in the stent.The prognosis of patients with acute thrombosis was significant improved after use rivaroxaban.
引文
[1] 中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南(第三版)[J].中华普通外科杂志,2017,32(9):807-812.
[2] KIBBE M R,UJIKI M,GOODWIN A L,et al.Iliac vein compression in an asymptomatic patient population [J].J Vasc Surg,2004,39(5):937-943.
[3] KNUTTINEN M G,NAIDU S,OKLU R,et al.May-thurner:diagnosis and endovascular management[J].Cardiov Diagn Ther,2017,7(Suppl 3):159-164.
[4] BUDNUR S C,SINGH B,MAHADEVAPPA N C,et al.Endovascular treatment of iliac vein compression syndrome(May-Thurner)[J].Cardiov Interv Ther,2013,28(1):101-105.
[5] SISTA A K,VEDANTHAM S,KAUFMAN J A,et al.Endovascular interventions for acute and chronic lower extremity deep venous dDisease:state of the art[J].Radiology,2015,276(1):31-53.
[6] HAGER E S,YUO T,TAHARA R,et al.Longterm outco-mes of endovascular intervention for may-thurner syndrome[J].J Vasc Surg Venous Lymphat Disord,2013,55(1):304.
[7] PARK J Y,AHN J H,JEON Y S,et al.Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome[J].Phlebology,2014,29(7):461-470.
[8] SEAGER M J,BUSUTTIL A,DHARMARAJAH B,et al.A systematic review of endovenous stenting in chronic venous disease secondary to iliac vein obstruction[J].Eur J Vasc Endovasc Surg,2015,51(1):100-120.
[9] BERGER A,JAFFE J W,YORK T N.Iliac compression syndrome treated with stent placement[J].J Vasc Surg,1995,21(3):510-514.
[10] WENDA W,YU Z,YUEXIN C.Stenting for chronic obstr-uctive venous disease:a current comprehensive meta-analysis and systematic review[J].Phlebology,2016,31(6):376-389.
[11] NEGLAN P,HOLLIS K C,OLIVIER J,et al.Stenting of the venous outflow in chronic venous disease:long-term stent-related outcome,clinical,and hemodynamic result[J].J Vasc Surg,2007,46(5):979-990.
[12] LE T B,LEE T K,PARK K M,et al.Contralateral deep vein thrombosis after iliac vein stent placement in patients with May-thurner syndrome[J].J Vasc Interv Radiol,2018,29(6):774-780.
[13] TITUS J M,MOISE M A,BENA J,et al.Iliofemoral stenting for venous occlusive disease[J].J Vasc Surg,2011,53(3):706-712.
[14] MAHNKEN A H,THOMSON K,DE H M,et al.CIRSE standards of practice guidelines on iliocavalstenting[J].Cardiovasc Intervent Radiol,2014,37(4):889-897.
[15] RAJU S.Best management options for chronic iliac vein stenosis and occlusion[J].J Vasc Surg,2013,57(4):1163-1169.
[16] 李晓强,李承龙.非血栓性髂静脉受压综合征诊治的问题与讨论[J].中华血管外科杂志,2016,1(1):13-15.
[17] WASSERLAUF G,GRANDI S M,FILION K B,et al.Meta-analysis of rivaroxaban and bleeding risk.[J].Am J Cardiol,2013,112(3):454-460.
[18] MILLER C S,GRANDI S M,SHIMONY A,et al.Meta-analysis of efficacy and safety of new oral anticoagulants(dabigatran,rivaroxaban,apixaban) versus warfarin in patients with atrial fibrillation[J].Am J Cardiol,2012,110(3):453-460.
[19] DOGLIOTTI A,PAOLASSO E,GIUGLIANO R P.Novel oral anticoagulants in atrial fibrillation:a meta-analysis of large,randomized,controlled trials vs warfarin[J].Clin Cardiol,2013,36(2):61-67.
[20] INOHARA T,XIAN Y,LIANG L,et al.Association of intracerebral hemorrhage among patients taking non-vitamin K antagonist vs vitamin K antagonist oral anticoagulants with in-hospital mortality[J].JAMA,2018,319(5):463-473.
[21] 王洛波,王兵,丁语,等.利伐沙班和华法林治疗下肢深静脉血栓形成的疗效比较[J].医药导报,2016,35(10):1089-1091.
[2] KIBBE M R,UJIKI M,GOODWIN A L,et al.Iliac vein compression in an asymptomatic patient population [J].J Vasc Surg,2004,39(5):937-943.
[3] KNUTTINEN M G,NAIDU S,OKLU R,et al.May-thurner:diagnosis and endovascular management[J].Cardiov Diagn Ther,2017,7(Suppl 3):159-164.
[4] BUDNUR S C,SINGH B,MAHADEVAPPA N C,et al.Endovascular treatment of iliac vein compression syndrome(May-Thurner)[J].Cardiov Interv Ther,2013,28(1):101-105.
[5] SISTA A K,VEDANTHAM S,KAUFMAN J A,et al.Endovascular interventions for acute and chronic lower extremity deep venous dDisease:state of the art[J].Radiology,2015,276(1):31-53.
[6] HAGER E S,YUO T,TAHARA R,et al.Longterm outco-mes of endovascular intervention for may-thurner syndrome[J].J Vasc Surg Venous Lymphat Disord,2013,55(1):304.
[7] PARK J Y,AHN J H,JEON Y S,et al.Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome[J].Phlebology,2014,29(7):461-470.
[8] SEAGER M J,BUSUTTIL A,DHARMARAJAH B,et al.A systematic review of endovenous stenting in chronic venous disease secondary to iliac vein obstruction[J].Eur J Vasc Endovasc Surg,2015,51(1):100-120.
[9] BERGER A,JAFFE J W,YORK T N.Iliac compression syndrome treated with stent placement[J].J Vasc Surg,1995,21(3):510-514.
[10] WENDA W,YU Z,YUEXIN C.Stenting for chronic obstr-uctive venous disease:a current comprehensive meta-analysis and systematic review[J].Phlebology,2016,31(6):376-389.
[11] NEGLAN P,HOLLIS K C,OLIVIER J,et al.Stenting of the venous outflow in chronic venous disease:long-term stent-related outcome,clinical,and hemodynamic result[J].J Vasc Surg,2007,46(5):979-990.
[12] LE T B,LEE T K,PARK K M,et al.Contralateral deep vein thrombosis after iliac vein stent placement in patients with May-thurner syndrome[J].J Vasc Interv Radiol,2018,29(6):774-780.
[13] TITUS J M,MOISE M A,BENA J,et al.Iliofemoral stenting for venous occlusive disease[J].J Vasc Surg,2011,53(3):706-712.
[14] MAHNKEN A H,THOMSON K,DE H M,et al.CIRSE standards of practice guidelines on iliocavalstenting[J].Cardiovasc Intervent Radiol,2014,37(4):889-897.
[15] RAJU S.Best management options for chronic iliac vein stenosis and occlusion[J].J Vasc Surg,2013,57(4):1163-1169.
[16] 李晓强,李承龙.非血栓性髂静脉受压综合征诊治的问题与讨论[J].中华血管外科杂志,2016,1(1):13-15.
[17] WASSERLAUF G,GRANDI S M,FILION K B,et al.Meta-analysis of rivaroxaban and bleeding risk.[J].Am J Cardiol,2013,112(3):454-460.
[18] MILLER C S,GRANDI S M,SHIMONY A,et al.Meta-analysis of efficacy and safety of new oral anticoagulants(dabigatran,rivaroxaban,apixaban) versus warfarin in patients with atrial fibrillation[J].Am J Cardiol,2012,110(3):453-460.
[19] DOGLIOTTI A,PAOLASSO E,GIUGLIANO R P.Novel oral anticoagulants in atrial fibrillation:a meta-analysis of large,randomized,controlled trials vs warfarin[J].Clin Cardiol,2013,36(2):61-67.
[20] INOHARA T,XIAN Y,LIANG L,et al.Association of intracerebral hemorrhage among patients taking non-vitamin K antagonist vs vitamin K antagonist oral anticoagulants with in-hospital mortality[J].JAMA,2018,319(5):463-473.
[21] 王洛波,王兵,丁语,等.利伐沙班和华法林治疗下肢深静脉血栓形成的疗效比较[J].医药导报,2016,35(10):1089-1091.