The change of blood coagulation by applying rivaroxaban and its effect on preventing venous thromboembolism after lumbar spine surgery in elderly

English Keywords:Rivaroxaban  Thromboelastography  Post lumbar surgery  Deep venous thrombosis

English Abstract:

  【Abstract】 Objectives: To observe the change of blood coagulation by applying rivaroxaban after lumbar spine surgery in elderly, and to evaluate its effectiveness and safety for preventing deep venous thrombosis(DVT). Methods: 220 patients who underwent lumbar surgery in our hospital from March 2012 to December 2015, were randomly assigned to rivaroxaban group(n=110) and parnaparin group(n=110). Rivaroxaban(10mg) and low-molecular-weight heparin calium (5000 IU) were used for anticoagulant therapy. The changes of blood coagulation were observed before surgery and on 1 and 4 days after surgery through thromboelastography (TEG), including coagulation reaction time(R), blood cell clot formation time(K), angle of solidification(α) and maximal amplitude(MA). The occurrence rate of DVT, hemorrhagic complication and volume of drainage at 48h were analyzed. Results: TEG of both groups showed that the R time(5.87±0.83min, 5.72±0.68min) and K time(1.56±0.30min, 1.49±0.34min) at postoperation were significantly shorter than those before operation(7.27±0.89min, 7.45±0.79min; 2.06±0.29min, 2.11±0.30min respectively)(P=0.000), while the α angle(66.21°±3.75°, 67.00°±3.43°) and MA(62.94±3.57mm, 63.65±5.06m) were significantly higher than those before operation(62.17°±3.59°, 61.39°±4.00°; 58.92±3.24mm, 58.20±3.26mm respectively)(P=0.000), suggesting an increase of blood clotting. After intervention(4 days), the R time(6.97±0.69min, 7.07±0.67min) and K time(1.97±0.31min, 2.04±0.32min) increased significantly(P=0.000), and the α angle(61.41°±4.04°, 62.16°±4.13°) and MA(58.15±2.97mm, 58.57±4.41mm) decreased significantly(P=0.000), suggesting that the high coagulation states of both groups were corrected, no significant difference between the two groups was noted(P>0.05). There were 9 asymptomatic DVT events(8.18%) in rivaroxaban group during 2-week follow-up while 6(5.45%) in parnaparin group, the difference between the two groups was not significant(χ2=0.64, P=0.422). There were 9 cases with bleeding events(8.18%) in rivaroxaban group while 7(6.36%) in parnaparin group, the difference between the two groups was not significant(χ2=0.27, P=0.604). And the volumes of drainage at 48h of two groups(412.30±44.65 ml, 421.71±43.45 ml, respectively) had no significant difference(t=-1.58, P=0.115). Conclusions: The blood coagulation increases after lumbar spine surgery in elderly. It can be corrected by rivaroxaban or low-molecular-weight heparin calium. And the effectiveness and safety between them for preventing DVT are equal.