| Objective: To observe the efficacy and safety of rivaroxaban on anticoagulation therapy in the acute phase of deep venous thrombosis(DVT)in the lower extremities after intracerebral hemorrhage(ICH).Method: A total of 52 cases of lower limb DVT complicated by cerebral hemorrhage from March 2021 to January 2023 were collected from the Department of Neurosurgery,Xianyang Hospital,Yan’an University.There were 35 male patients and 17 female patients with an average age of(63.81±9.04)years.The onset of lower limb DVT was 14-25 days after admission.17 patients were treated with craniotomy,25 patients were treated with conservative internal medicine,and 10 patients were treated with minimally invasive removal of intracranial hematoma.All patients met the inclusion and exclusion criteria of this topic,and the medical history,symptoms,physical examination and auxiliary examinations were accurately collected.Changes in D-dimer index,thrombus as indicated by color Doppler ultrasound of the lower limb deep vein vessels,and changes in Wells score before and after treatment were analyzed to assess the main efficacy.Treatment safety was assessed for changes in intracranial hematoma,platelets,coagulation series(APTT,PT,TT,INR),urinalysis and urinary sediment,stool routine,gastric fluid routine,skin petechiae,nasal bleeding,corneal flushing,and gingival bleeding before and after treatment.The study data were analyzed using the SPSS26.0 software system,and differences were suggested to be statistically significant when P < 0.05.Results: 1.Analysis of D-dimer changes before and after anticoagulation therapy:The analysis of D-dimer changes before and after anticoagulation therapy in 52 patients showed that: D-dimer was(0.79±0.59)mg/L at the time of admission,D-dimer was(4.55±5.84)mg/L at the time of thrombosis,and D-dimer was(1.59±1.35)mg/L after treatment.It was seen that D-dimer at the time of thrombosis was significantly higher than D-dimer at the time of admission,and the difference was statistically significant(P < 0.05).After anticoagulation therapy,the D-dimer was significantly lower than that at the time of thrombosis,and the difference was statistically significant(P < 0.05);analysis of the results of color Doppler ultrasound examination of lower limb veins before and after anticoagulation therapy in 52 patients showed that 9 cases(17.31%)were cured,21 cases(40.38%)were effective,18 cases(34.62%)were effective,and 4 cases(7.69%)were ineffective after anticoagulation therapy.The total effective rate was 92.31%;the Wells DVT score of 52 patients before and after anticoagulation therapy was compared and analyzed: the Wells score was(1.08±0.269)at the time of admission,(2.67±0.564)at the time of thrombosis,and(1.19±0.398)after treatment.There was a statistically significant difference between the Wells DVT score at the time of thrombosis and at the time of admission(P < 0.05);there was a statistically significant difference between the Wells DVT score after anticoagulation therapy and at the time of thrombosis in patients(P <0.05).2.Analysis of changes in relevant laboratory tests before and after anticoagulation therapy in 52 patients: platelets were(212.58±60.507)×10^9/L before treatment and(215.817±63.838)×10^9/L after treatment;APTT was(26.081±2.663)s before treatment and(25.644±1.819)s after treatment;TT was(15.515±1.819)s before treatment TT was(15.515±0.976)s before treatment and(15.525±0.932)s after treatment;PT was(10.965±1.45)s before treatment and(10.563±0.83)s after treatment;INR value was0.94±0.13 before treatment and 0.9396±0.81 after treatment;2 cases of positive urinary occult blood before treatment and 3 cases after treatment;there were 0 cases of positive fecal occult blood before treatment and 3 cases after treatment;4 cases of occult blood in gastric contents before treatment and 2 cases after treatment.The differences between the above two comparisons were not statistically significant(P > 0.05).Rivaroxaban was used to treat 52 patients in the acute phase of cerebral hemorrhage complicated by lower limb deep vein thrombosis,among which 17 patients were treated with craniotomy,25 patients were treated with conservative internal medicine,and 10 patients were treated with minimally invasive removal of intracranial hematoma.After anticoagulation with rivaroxaban,there was no case of recurrence of cerebral hemorrhage or increase of the original hematoma.The safety of the use of rivaroxaban for the treatment of cerebral hemorrhage complicated by deep vein thrombosis in the lower extremities in this study was indirectly confirmed;bleeding from other sites before and after treatment in 52patients: 0 cases of skin petechiae before treatment and 1 case after treatment in patients.Patients had gingival bleeding before treatment in 0 cases,and gingival bleeding after treatment in 2 cases.There were 0 cases of corneal reddening before treatment and 2 cases of corneal reddening after treatment.There was no statistically significant difference between skin petechiae,gingival bleeding,corneal flushing and nasal bleeding before and after treatment in 52 patients(P > 0.05).Conclusion: Rivaroxaban improves the formation of lower limb deep vein thrombosis in the acute phase of anticoagulation after cerebral hemorrhage complicated by lower limb deep vein thrombosis,and there was no recurrence of intracranial hematoma or enlargement of the original hematoma,and no complications of increased bleeding.The number of cases in this study was small and not representative of the total number of patients with lower extremity DVT in the acute phase after cerebral hemorrhage,and we need to further expand the number of cases in the study to further observe the efficacy and safety. |
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