目的 比较阿加曲班和利伐沙班在急性静脉血栓形成患者中的疗效和不良反应。方法 采用回顾性研究方法分析武汉协和医院2010年6月至2012年6月收治的静脉血栓栓塞症患者254例。将患者分为对照组（98例）、阿加曲班组（101例）和利伐沙班组（55例）。对照组给予普通肝素1.25×104 U加生理盐水配制成48 mL，2 mL/h, 24 h静脉持续泵入，疗程7 d；阿加曲班组患者开始2 d，阿加曲班注射液40 mg以适当生理盐水配制成96 mL，以4 mL/h，24 h静脉持续泵入，后5 d，阿加曲班注射液20 mg以适当生理盐水配制成48 mL，2 mL/h，24 h静脉持续泵入，疗程7 d；利伐沙班组予以利伐沙班片10 mg/d，口服，疗程7 d。每日测量患者双下肢周径，监测凝血功能，血、尿常规及大便潜血等实验室指标，另外检测用药前和用药第7日的D-二聚体水平并观察患者有无出血倾向及出血。所有患者7 d后改为口服华法林治疗3～6月，检测INR值，调整华法林剂量，维持INR值于2.0～3.0。结果 经过7 d治疗后，阿加曲班组下肢肿胀缓解率为95%，利伐沙班组为89%，对照组为96%，3组比较无差异。用药7 d后，3组D-二聚体水平变化差异无统计学意义。阿加曲班组、利伐沙班组出血不良反应发生率低于对照组（P＜0.05）。结论 阿加曲班和利伐沙班作为新型抗凝药物，其临床疗效与传统抗凝药物普通肝素相比无明显差异，但阿加曲班相比于普通肝素出血等不良反应较少，同时，不会引起患者血小板减少。

Objective To compare the curative effect and adverse reaction of argatroban and rivaroxaban in acute venous thrombosis patients. Methods Patients (254 cases) with venous thromboembolism in Wuhan Union Hospital from June 2010 to June 2012 were analyzed by retrospective study method. The patients were randomly divided into the control (98 cases), argatroban (101 cases), and rivaroxaban (55 cases) groups. The patients in the control group were administered with ordinary heparin 1.25×104 U in 48 mL normal saline, 2 mL/h, by iv continuous pumping, for 7 d. The patients in the argatroban group were administered with argatroban (40 mg/d) in 96 mL normal saline with 4 mL/h in first 2 d and 20 mg/d in 48 mL normal saline with 2 mL/h in last 5 d, the course of treatment was 7 d. The patients in the rivaroxaban group were po with rivaroxaban (10 mg/d), for 7 d as one course. The diameters of double lower limbs were measured daily, and the blood coagulation function, blood routine test , routine urine test, and occult stool test were monitored. Besides, the D-dimer level was detected before anticoagulation treatment and after 7 d of the treatment, and the bleeding tendency of patients was observed. After 7 d, all patients were po Huafalin for three or six months. INR value was tested, and the dosage of Huafalin was adjusted to maintain the INR value from 2 to 3. Results After 7 d of the treatment, the lower limb swelling remission rate of the argatroban group was 95%, and those of rivaroxaban and control groups were 89% and 96%, respectively. There was no significant difference in the three groups. The concentration of D-dimer in the three groups were no statistical difference. Adverse reactions of bleeding in argatroban and rivaroxaban groups were lower than that in the control group (P < 0.05). Conclusion Argatroban and rivaroxaban as new anticoagulant drugs show no distinguishable clinical curative effect compared with the traditional ordinary heparin. Argatroban is with less adverse reaction compared to the ordinary heparin, and doesn’t cause thrombocytopenia.