The Research Of Curative Effect About Anticoagulation Of Applying Rivaroxaban After Small And Micro Vascular Anastomosis

Objective: The small or micro vascular must be anastomosesed to makethe tissues transplanted alive in the operations of the fingers or limbsreplantation, the fingers reconstruction, free skin flap, free bone flap. Butduing to suffering from various factors outside or inside the organism, it canbring hypercoagulability to the body. And it offen leads to form thrombus inthe vacular anastomotic stoma, which causes these operations failed. So wemust to use anticoagulant rulely to prevent thrombus forming in the small ormicro vascular afteroperation. Now the drugs with regard to anticoagulantionis various which is used after the operations of small or micro vascularanastomosis, and the same to the researches of method about anticoagulantion.However, mojority of the anticoagulant drugs, anticoagulant methods whetherhas poor curative effect or generates a lot of subsidiary reaction. So it cannotachieve the satisfactory effectiveness. This research analyzed and contrastedthe curative effect and the side effect of the two anticoagulant drugs throughthe new oral anticoagulant drug Rivaroxaban and traditional anticoagulantdrug Heparin Sodium routinely used after the operations of small and microvascular anastomosis. We used the Rivaroxaban and the Heparin Sodium toanticoagulate independently after the operations for the patients who matchedthe conditions, such as the one who was carried out the operations of thefingers or limbs reimplantation,the fingers reconstruction,the free skin flap andthe free bone flap. We monitored the hemagglutinin indexes of this patients,observed and recorded the cases of necrotic tissues,the information which theblood vessel articulo and obviously hemorrhagic tendency were taken place.And we carried out statistical analysis for the data. Through these indexes, weanalyzed the anticoagulant curative efect and side reaction of the two drugs used after operations of small and micro vascular anastomosis, which in orderto provide evidence for the Rivaroxaban used in the clinic to anticoagulateafter the operations of small and micro vascular anastomosis.Method: From February2010to February2012, acording to the calibersize of vessels anastomosed, we divided100patients who matched theconditions into the small vessels part(1.5mm<caliber size<10mm) and themicro vessels part(caliber size<1.5mm). Each part50cases,and which wasdivided into the reseach group and the control group, each group25cases.The choice of cases:⑴t he small vessels part:①aged between20and55;②the one whose limbs away from mesomer of upper arms were uniplanarlyand completely amputated; cutaneous deficiency of four limbs, the one mustbe carried out the operations of the free skin flap or the free bone flap to repairthe wound surface(the deletion area<15cm×10cm, we did not useanticoagulant drugs in order to prevent extensive capillary from the woundwith regard to the flap whose area was comparatively large); the thumbscomplete collyriculum, the one must be carried out the operations of the bigtoe nail flap or the second toe free grafting to reconstruct thumbs;③did notcontract the diseases of hematological system or other systemic diseaseswhich affected the tissues healing;④each chemical analysis and examinationwere all normal preoperative;⑵the micro vessels part:①aged between20and55;②single finger uniplanarly(from the second finger to the fourth finger)and completely amputation from proximal or middle phalanx, thumbscompletely amputation from proximal phalanx;③did not contract the diseasesof hematological system or other systemic diseases which affected the tissueshealing;④each chemical analysis and examination were all normalpreoperative.There were50cases in the small vessels part, and each25casesindependently in the reseach group and the control group. The patientsindependently took Rivaroxaban orally and infused Heparin Sodium bycomputer infusion pumps to prevent the vascular anastomotic stoma formingthrombotic continuously for10days. We observed and recorded the cases of necrotic tissues,the information which the blood vessel articulo and obviouslyhemorrhagic tendency were taken place, monitored the hemagglutinin indexes(PT and APTT) of this patients, And we carried out statistical analysis for thedata.Base on the reseach of the small vessels part, we reseached the microvessels part, which50cases in it, and each25cases independently in thereseach group and the control group. The patients independently tookRivaroxaban orally and infused Heparin Sodium by computer infusion pumpsto prevent the vascular anastomotic stoma forming thrombotic continuouslyfor10days. We observed and recorded the cases of necrotic reimplantationfingers,the information which the blood vessel articulo and obviouslyhemorrhagic tendency were taken place, monitored the hemagglutinin indexes(PT and APTT) of this patients, And we carried out statistical analysis for thedata.Results:1The small vessels part: there was none case necrosed,2cases generatedthe blood vessel articulo, and1case generated the obviously hemorrhagictendency in the reseach group after operations; there were2cases necrosed,8cases generated the blood vessel articulo, and9cases generated the obviouslyhemorrhagic tendency in the control group after operations. There were notstatistics differences about the comparion of mortification after operationsbetween two groups(Χ2=2.083,P>0.05), There were obvious statisticsdifferences about the comparion of incidence rate of the blood vessel articuloand obviously hemorrhagic tendency after operations between two groups(Χ2=4.500,P<0.05;Χ2=8.000,P<0.05). With regard to comparing thehemagglutinin indexes, we reseached the regularity changed of thehemagglutinin indexes by the relative value among the value of PT and APTTof the first day,the fifth day,the nineth day after operations and valuepreoperative(we designed T1:the value of the first day after operations/thevalue preoperative, T2:the value of the fifth day after operations/the valuepreoperative, T₃:the value of the nineth day after operations/the value preoperative): there were not statistics differences about the comparion ofT₁,T₂,T₃of PT in two groups, there wer(et=1.407,P>0.05)(,t=1.825,P>0.05),(t=1.637,P>0.05)independently. There were also not statistics differencesabout the comparion of T₁,T₂,T₃of APTT in two groups, there were(t=1.947,P>0.05),(t=1.566,P>0.05),(t=1.056,P>0.05)independently. Wereseached the diversity of hemagglutination indexes through thePaired-Samples T Test in the same groups: PT of the reseach group: T₂compared with T₁(:t=9.435,P<0.05), T₃compared with T₂:(t=5.082,P<0.05);APTT of the reseach group: T₂compared with T₁:(t=19.591,P<0.05), T₃compared with T₂:(t=6.209,P<0.05. PT of the control group: T₂comparedwith T₁:(t=9.925,P<0.05),T₃compared with T₂:(t=4.330,P<0.05); APTTof the control group: T₂compared with T₁:(t=22.577,P<0.05), T₃comparedwith T₂:(t=7.960,P<0.05). There were obvious statistics differences abouthemagglutinin indexes of different days in the same groups.2The micro vessels part: there were2cases necrosed,3cases generatedthe blood vessel articulo, and4cases generated the obviously hemorrhagictendency in the reseach group after operations; there were4cases necrosed,10cases generated the blood vessel articulo, and11cases generated theobviously hemorrhagic tendency in the control group after operations. Therewere not statistics differences about the comparion of mortification afteroperations between two groups(Χ2=0.758,P>0.05), There were obviousstatistics differences about the comparion of incidence rate of the blood vesselarticulo and obviously hemorrhagic tendency after operations between twogroups(Χ2=5.094,P<0.05;Χ2=4.667,P<0.05). With regard to comparing thehemagglutinin indexes, we reseached the regularity changed of thehemagglutinin indexes by the relative value among the value of PT and APTTof the first day,the fifth day,the nineth day after the operations and valuepreoperative(we designed T₁:the value of the first day after operations/thevalue preoperative, T₂:the value of the fifth day after operations/the valuepreoperative, T₃:the value of the nineth day after operations/the valuepreoperative): there were not statistics differences about the comparion of T₁,T₂,T₃of PT in two groups, there were(t=1.663,P>0.05)(,t=1.381,P>0.05),(t=1.498,P>0.05)independently. There were also not statistics differencesabout the comparion of T₁,T₂,T₃of APTT in two groups, there were(t=1.252,P>0.05),(t=0.114,P>0.05),(t=1.511,P>0.05)independently. Wereseached the diversity of hemagglutination indexes through thePaired-Samples T Test in the same groups: PT of the reseach group: T₂compared with T₁(:t=6.042,P<0.05), T₃compared with T₂:(t=4.219,P<0.05);APTT of the reseach group: T₂compared with T₁:(t=17.128,P<0.05), T₃compared with T₂:(t=12.810,P<0.05). PT of the control group: T₂comparedwith T₁:(t=7.289,P<0.05),T₃compared with T₂:(t=3.992,P<0.05); APTTof the control group: T₂compared with T₁:(t=16.803,P<0.05), T₃comparedwith T₂:(t=11.528,P<0.05). There were obvious statistics differences abouthemagglutinin indexes of different days in the same groups.Conclusion:1Whether in the small vessels part or in the micro vessels part, therewere not obvious differences about the survival rate of tissues in the reseachgroup compared with control group. This demonstrated it did not obviouslyincrease the survival rate of tissues when we used Rivaroxaban toanticoagulate.2Whether in the small vessels part or in the micro vessels part, theincidence of blood vessel articulo and obviously hemorrhagic tendency in thereseach group was obviously depressed compared with the control group. Thisdemonstrated that compared with Heparin Sodium, the anticoagulant effect ofRivaroxaban was powerful, and the side effect was few, when we used it afteroperations of small or micro vessels anastomosis.3Whether in the small vessels part or in the micro vessels part, the valueof PT and APTT was obviously heightened along with the days of drugadministration. This demonstrated the interior and extrinsic coagulation wayssuffered from restraining, so it prevented the thrombopoiesis.4Whether in the small vessels part or in the micro vessels part, therewere not obvious differences about the heightened value of PT and APTT in the reseach group compared with the control group. This demonstrated thatcompared with Heparin Sodium, it did not obviously increase the value ofhemagglutinin indexes, when we used Rivaroxaban to anticoagulate.5New anticoagulant drug Rivaroxaban is administrated orally, and we donot need to monitor the hemagglutinin indexes. The anticoagulant effect ofRivaroxaban is precisely,and it is secure when we use it. So it can beavailablely used for anticoagulant therapy after small and micro vesselsanastomosis.