目的 比較利伐沙班片和低分子肝素鈣注射液預(yù)防老年關(guān)節(jié)置換術(shù)后下肢深靜脈血栓的臨床療效。方法 選取2015年2月—2016年5月天津港口醫(yī)院收治的關(guān)節(jié)置換術(shù)患者120例為研究對象，所有患者根據(jù)用藥方案不同分為低分子肝素組（64例）和利伐沙班組（56例）。低分子肝素組術(shù)后皮下注射低分子肝素鈣注射液，0.2 mL/次，1次/d，第3天后劑量調(diào)整為0.4 mL/d。利伐沙班組術(shù)后口服利伐沙班片，10 mg/次，1次/d。兩組患者連續(xù)治療10 d。比較觀察兩組的深靜脈血栓發(fā)生率、術(shù)中失血量、血液相關(guān)指標和血栓彈力圖（TEG）。結(jié)果 治療后，兩組深靜脈血栓發(fā)生率比較差異無統(tǒng)計學(xué)意義。在關(guān)節(jié)置換手術(shù)中，兩組術(shù)中總失血量和顯性失血量比較差異無統(tǒng)計學(xué)意義。術(shù)后2、4 d，兩組血紅蛋白、血小板計數(shù)、PT和APTT比較差異無統(tǒng)計學(xué)意義。術(shù)后2、4 d，利伐沙班組D-二聚體（D-D）和纖維蛋白降解產(chǎn)物（FDP）顯著低于低分子肝素組，國際標準化比值（INR）顯著高于低分子肝素組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。術(shù)后2 d，利伐沙班組凝血因子反應(yīng)時間（R）、血凝塊成形時間（K）顯著高于低分子肝素組，描記圖最大曲線弧度作切線與水平線的夾角（Angle）、最大振幅（MA）和綜合凝血指數(shù)（CI）顯著低于低分子肝素組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。在治療期間，低分子肝素組和利伐沙班組不良反應(yīng)總發(fā)生率分別為46.88%、37.50%，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 利伐沙班片預(yù)防老年關(guān)節(jié)置換術(shù)后下肢深靜脈血栓優(yōu)于低分子肝素鈣注射液，可降低血液高凝狀態(tài)，安全性較好，具有一定的臨床推廣應(yīng)用價值。

Objective To compare the clinical effect of Rivaroxaban Tablets and Low-Molecular-Weight Heparins Calcium Injection in prevention of deep venous thrombosis of lower extremity after joint replacement of elderly patients. Methods Patients (120 cases) with joint replacement in Tianjin Port Hospital from February 2015 to May 2016 were enrolled in this study. According to the difference treatment plan, patients were divided into the low molecular weight heparin group (64 cases) and the rivaroxaban group (56 cases). Patients in the low molecular weight heparin group were sc administered with Low-Molecular-Weight Heparins Calcium Injection after the operation, 0.2 mL/time, once daily, and since 3th day, the dose was adjusted to 0.4 mL/d. Patients in the rivaroxaban group were po administered with Rivaroxaban Tablets, 10 mg/time, once daily. Patients in two groups were treated for 10 d. After treatment, the incidences of deep venous thrombosis were evaluated, and intraoperative blood loss, blood related indexes, and TEG in two groups were compared. Results After treatment, there was no significant difference in the incidence of deep venous thrombosis between two groups. In the arthroplasty, there was no significant difference in the total blood loss and the dominant blood loss in two groups. At 2 and 4 d after operation, there was no significant difference on hemoglobin, platelet count, PT and APTT between two groups. At 2 and 4 d after operation, the D-D and FDP in the rivaroxaban group were significantly lower than those in the low molecular weight heparin group, but the INR in the rivaroxaban group was significantly higher than that in the low molecular weight heparin group, and there was difference between two groups (P < 0.05). At 2 d after operation, the R and K in the rivaroxaban group were significantly higher than those in the low molecular weight heparin group, but the Angle, MA, and CI in the rivaroxaban group were significantly lower than that in the low molecular weight heparin group, and there was difference between two groups (P < 0.05). During the period of treatment, the incidence of adverse reactions in the low molecular weight heparin group and rivaroxaban group were 46.88% and 37.50%, respectively, and there was difference between two groups (P < 0.05). Conclusion Rivaroxaban Tablets were better than Low-Molecular-Weight Heparins Calcium Injection in prevention of deep venous thrombosis of lower extremity after joint replacement of elderly patients, can decrease hypercoagulable state of blood, with good safety, which has a certain clinical application value.