目的 观察利伐沙班治疗老年恶性肿瘤并发下肢深静脉血栓(DVT)的疗效及安全性。方法 选取2011年12月—2014年12月在桂林医学院附属医院治疗的老年恶性肿瘤并发DVT患者76例, 随机分成对照组和治疗组, 每组38例。对照组sc低分子肝素钙注射液4 250 U/次, 1次/d。治疗组口服利伐沙班片, 1片/次, 1次/d。两组均连续治疗24 d。观察两组患者的临床疗效, 同时比较两组治疗前后下肢周径差、血流速度的变化, 同时检测用药后D-二聚体、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)等指标, 评估药物的安全性。结果 治疗后, 对照组和治疗组总有效率分别为86.84%、97.37%, 两组比较差异具有统计学意义(P<0.05)。治疗后, 两组患者下肢周径差显著缩小, 同时血流速度显著升高, 同组治疗前后差异有统计学意义(P<0.05);且治疗组这两个指标的改善程度优于对照组, 两组比较差异有统计学意义(P<0.05)。治疗后, 两组患者PT、APTT差异无统计学意义, 治疗组D-二聚体显著低于对照组, 差异有统计学意义(P<0.05)。两组均没有出血患者。结论 利伐沙班治疗老年恶性肿瘤并发下肢深静脉血栓疗效确切, 同时具有良好的安全性, 不会增加出血的不良事件。

Objective To investigate the efficacy and safety of rivaroxaban in treatment of elderly malignant tumor complicated with lower limb deep vein thrombus. Methods Patients (78 cases) with elderly malignant tumor complicated with lower limb deep vein thrombus in Affiliated Hospital of Guilin Medical University December 2011 to December 2014 were randomly divided into control and treatment groups. Each group had 38 cases. Patients in the control group were sc administered with Low-Molecular-Weight Heparins Calcium Injection, 4 250 U/time, once daily. Patients in treatment group were po administered with Rivaroxaban Tablets, 1 tablet/time, once daily. Two groups were treated for 24 d. After treatment, the efficacy was evaluated, and the changes of lower limb diameter difference and blood flow velocity in two groups were compared. While the indexes of D-dimer, APTT, and PT in two groups were detected so as to evaluate the safety of drugs. Results The efficacies in the control and treatment groups were 86.84% and 97.37%, respectively, and there were differences between two groups (P < 0.05). After treatment, lower limb diameter difference significantly reduced, blood flow velocity significantly elevated, and the difference was statistically significant in the same group (P < 0.05). And these indicators in treatment group improved better than those in the control group, with significant differences between two groups (P < 0.05). After treatment, there was no statistically significant difference of PT and APTT between two groups of patients. D-dimer in treatment group was significantly lower than that in the control group, with significant differences between two groups (P < 0.05). There were no hemorrhage patients in two groups. Conclusion Rivaroxaban has the good clinical effect in treatment of elderly malignant tumor complicated with lower limb deep vein thrombus, and it has good security, which will not increase bleeding adverse events.