摘要
目的对比髂静脉支架置入后不同药物方案预防支架内血栓的疗效及出血风险,探讨髂静脉支架置入术后血栓的药物预防策略。方法回顾性分析商丘市第一人民医院2019年1月—2021年6月就诊的97例髂静脉受压综合征并置入支架患者,按治疗方案不同分为三组,抗凝组为利伐沙班20 mg组(组1,31例),抗凝+抗板组为利伐沙班10 mg+阿司匹林组(组2,37例),抗板组为单纯阿司匹林组(组3,29例)。术后用药疗程12个月,分别于术后不同时间(1个月、3个月、6个月、12个月、24个月)随访三组彩超或静脉造影检查结果,判断髂静脉支架内血栓情况。同时,比较三组血栓及出血事件发生率。结果97例患者全部获得随访,24个月时支架内血栓发生率抗板组(组3)为27.59%,抗凝组(组1)为9.68%,抗凝+抗板组(组2)为2.70%,三组血栓发生率比较差异有统计学意义(P<0.05)。抗板组(组3)总出血率为10.34%,抗凝组(组1)为29.03%,抗凝+抗板组(组2)为32.43%,三组总出血率比较差异无统计学意义(P>0.05),组1+组2总出血率为30.88%,高于组3的10.34%,差异有统计学意义(P<0.05)。组1、组2、组3三组轻度出血发生率分别为25.81%、27.03%和6.90%(P>0.05),严重出血发生率分别为3.23%、5.41%和3.45%(P>0.05)。结论利伐沙班10 mg联合阿司匹林预防髂静脉支架内血栓疗效更好,能显著降低支架内血栓发生率,提高髂静脉支架通畅率,且出血风险未明显增加,在预防髂静脉支架置入术后血栓方面具有一定优势,值得临床应用。
Objective To compare the efficacy and bleeding risk of different drug regimens for preventing stent thrombosis after iliac vein stent placement,so as to explore drug prevention strategies for thrombosis after iliac vein stent surgery.Methods A retrospective analysis was conducted on 97 patients with iliac vein compression syndrome treated with stents at the First People's Hospital of Shangqiu from January 2019 to June 2021.They were divided into three groups according to different treatment plans:anticoagulant group were treated with rivaroxaban 20 mg(Group 1,31 cases),anticoagulant+antiplatelet group were treated with rivaroxaban 10 mg+aspirin(Group 2,37 cases),and antiplatelet group were treated with aspirin alone(Group 3,29 cases).Postoperative medication course was 12 months,and the results of color ultrasound or venous angiography results of the three groups were followed up at different times(1 month,3 months,6 months,12 months,24 months)to estimate the thrombosis situation in the iliac vein stent.Meanwhile,the incidence of thrombosis and bleeding events was compared among the three groups.Results All 97 patients were followed up,and at 24 months,the incidence of stent thrombosis in the antiplatelet group(Group 3),the anticoagulant group(Group 1),and the anticoagulant+antiplatelet group(Group 2)was 27.59%,9.68%and 2.70%,respectively,and the difference of the incidence of thrombosis among the three groups was statistically significant(P<0.05).The total bleeding rate of the antiplatelet group(Group 3),the anticoagulant group(Group 1),and the anticoagulant+antiplatelet group(Group 2)was 10.34%,29.03%and 32.43%,respectively,and difference was not statistically significant(P>0.05).The total bleeding rate of Group 1+Group 2 was 30.88%,which was higher than that of the Group 3(10.34%),and difference was statistically significant(P<0.05).The incidence rates of mild bleeding in the Group 1,the Group 2,and the Group 3 were 25.81%,27.03%,and 6.90%,respectively(P>0.05),while the incidence rates of severe bleeding in the Group 1,the Group 2,and the Group 3 were 3.23%,5.41%,and 3.45%,respectively(P>0.05).Conclusion Rivaroxaban 10 mg combined with aspirin has a better therapeutic effect in preventing thrombosis in iliac vein stents.It can significantly reduce the incidence of thrombosis in stents,improve the patency rate of iliac vein stents without significantly increasing the risk of bleeding,which has certain advantages in preventing thrombosis after iliac vein stent placement and is worthy of clinical application.
作者
索飞飞
庞宏永
田珂
SUO Feifei;PANG Hongyong;TIANKe(Department of Vascular Surgery,the First People's Hospital of Shangqiu,Shangqiu 476000,Henan,China)
出处
《右江医学》
2024年第5期430-434,共5页
Chinese Youjiang Medical Journal
