Comparison Of The Safety And Efficacy Of Different Drugs In Perioperative Anticoagulation Of Intertrochanteric Fractures

Objective:The safety and efficacy of three different drugs(aspirin,rivaroxaban and low molecular weight heparin)in the perioperative anticoagulation of elderly intertrochanteric fractures were compared.The optimal drugs were screened to better guide clinical anticoagulation therapy,so as to provide a more comprehensive reference for perioperative anticoagulation therapy for elderly patients with intertrochanteric fractures.Methods:According to the pre-designed experimental method,the inclusion and exclusion criteria were formulated.A total of 90 patients who underwent proximal femoral anti-rotation intramedullary nail fixation for intertrochanteric fractures in our hospital from October 2016 to June 2018 were collected and divided into three groups A,B,and C according to the random number table method.Patients in group A received aspirin enteric-coated tablet orally,patients in group B were injected with low molecular weight heparin sodium,and patients in group C received rivaroxaban orally.All patients were treated continuously until the fifth week after operation.The intraoperative blood loss,complication occurrence within 30 days after operation,anticoagulation efficiency,the coagulation function indexes,D-dimer concentration,high-sensitivity C-reactive protein level,platelet count and hemoglobin level before operation and three days after operation were recorded and analyzed among the three groups.Results:1.There were no significant difference in gender,age,fracture type and BMI among the three group of patients,and they were comparable(P>0.05).2.Among the 90 patients,7 patients developed deep vein thrombosis of lower limbs,accounting for 7.78% of the total.There were 4 cases in group A,accounting for 13.33%.There was 1 case in group B,accounting for 3.33%.There were 2 cases in group C,accounting for 6.67%.No pulmonary embolism occurred.There was no significant difference in the incidence of DVT among the three groups(P>0.05)3.Hemorrhage complications occurred in 7 of the 90 patients,all of which were subcutaneous ecchymosis around the incision,accounting for 7.78% of the total.There were 2 cases in group A,accounting for 6.67%.There were 2 cases in group B,accounting for 6.67%.There were 3 cases in group C,accounting for 10%.There was no significant difference in the incidence of bleeding events among the three groups(P>0.05).4.There were no statistically significant differences in PT,D-Dimer,HS-CRP,intraoperative blood loss,perioperative blood loss,hemoglobin count and other aspects among the three groups(P>0.05).There was no significant difference in platelet count before and after operation in aspirin group(p>0.05),but there was significant difference in platelet count before and after operation in the other two groups(P < 0.05).In aspirin group,the preoperative activated partial thromboplastin time(APTT)was 30.50±5.93 s,the first day after operation was 29.16±4.92 s,and the third day after operation was 29.50 ± 4.98s;In low molecular weight heparin sodium group,APTT was 30.42±5.70 s,the first day after operation was 31.17±5.46 s,and the third day after operation was 31.29±5.38s;In rivaroxaban group,the APTT was 29.46±4.86 s,the first day after operation was 34.89±3.87 s,and the third day after operation was 44.89 ± 3.87s;The results showed that the APTT of rivaroxaban patients was significantly higher than that of the other two groups(P <0.05).5.Aspirin was the cheapest(about RMB 41),followed by low molecular weight heparin sodium(about RMB 912),and rivaroxaban was most expensive(about RMB1400).Conclusion:1.Aspirin,low-molecular-weight heparin calcium and rivaroxaban have good efficacy and safety in preventing deep vein thrombosis after intertrochanteric fracture,and individualized anticoagulation regimen should be adopted clinically.2.Aspirin is convenient for oral administration,cheap,relatively safe,and can be taken for a long time.For patients with low risk of thrombophilia and no contraindications,aspirin can be used to prevent the formation of lower extremity deep vein thrombosis after intertrochanteric fractures.3.The APTT level increased significantly after rivaroxaban was used,but the incidence of bleeding events,intraoperative blood loss and perioperative blood loss were comparable to aspirin and low molecular weight heparin.Therefore,rivaroxaban can be routinely used for perioperative anticoagulation in patients with intertrotroteric fractures.Rivaroxaban has the characteristics of convenient oral administration and high effectiveness in preventing VTE.It is suitable for use when patients have multiple risk factors for thrombosis and need long-term anticoagulation.However,it has the disadvantages of being expensive.4.Low molecular weight heparin calcium has the best effect on the prevention of lower extremity deep vein thrombosis in patients with intertrochanteric fracture of femur.However,due to its subcutaneous injection and inconvenient medication after discharge,it should be the first choice for anticoagulant preventive treatment in hospital.