目的 探讨阿司匹林与利伐沙班预防全膝关节置换后下肢深静脉血栓（DVT）的疗效。方法 选取200例需行全膝关节置换术的患者，随机分为两组，阿司匹林组（98例）术后12 h开始口服阿司匹林，利伐沙班组（102例）术后12 h开始口服利伐沙班，通过术前术后凝血指标、D-二聚体水平及围手术期并发症发生情况，评价阿司匹林与利伐沙班预防全膝关节置换后下肢DVT的疗效。结果 术前，两组各项凝血指标相比，差异没有统计学意义。术后3d，两组血小板值（Plt）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）与术前相比，差异没有统计学意义。阿司匹林组纤维蛋白原（FIB）水平明显升高（P<0.05），高于利伐沙班组，而利伐沙班组FIB水平接近术前正常水平。术前两组D-二聚体数值相比，差异无统计学意义；与术前相比，术后1、3、7d，两组D-二聚体数值明显上升（P<0.05），但术后3d和术后7d两组D-二聚体数值开始出现下降趋势。此外，术后1、3、7d利伐沙班组患者体内D-二聚体数值低于同时期阿司匹林组（P<0.05）。围手术期两组DVT发生率相比，差异无统计学意义。结论 利伐沙班可以有效预防全膝关节置换后下肢深静脉血栓的形成，降低体内D-二聚体的水平，抗凝效果好且用药安全性较高，值得临床推广使用。

Objective To compare the efficacy of aspirin and rivaroxaban on prevention of deep vein thrombosis after total knee repalcement. Methods Patients (200 cases) who were given total knee replacement were selected, and the patients in aspirin group(98 cases) were administered with asprin after 12 h treatment, and the patients in rivaroxaban group(102 cases) were administered with rivaroxaban after 12 h treatment. The efficacy of aspirin and rivaroxaban to prevent deep vein thrombosis after total knee repalcement was evaluated by blood coagulation indexes, D-dimer level, and complication during perioperative period. Results Before surgery, there was no statistically significant difference on coagulation indexes between two groups. After 3 d of operation, there was no statistically significant difference in Plt, APTT, and PT between two groups. The FIB level of aspirin group was improved significantly and higher than that of rivaroxaban group(P<0.05). While the FIB level of rivaroxaban group was close to the normal level. Before operation, there was no statistically significant difference in D-dimer between two groups. After 1, 3, and 7 d of operation, the D-dimer levels in two groups were increased. But the D-dimer levels of 3 and 7 d after operation began to decline. After 1, 3, and 7 d of operation, the D-dimer of rivaroxaban group was lower than that of aspirin group(P<0.05). During perioperative period, there was no statistically significant difference on DVT between two groups. Conclusion Rivaroxaban could prevent the formation of DVT effectively and reduce the D-dimer with good anticoagulation and high safety. It is worthy of clinical application.