目的 比較阿加曲班和利伐沙班在急性靜脈血栓形成患者中的療效和不良反應(yīng)。方法 采用回顧性研究方法分析武漢協(xié)和醫(yī)院2010年6月至2012年6月收治的靜脈血栓栓塞癥患者254例。將患者分為對照組（98例）、阿加曲班組（101例）和利伐沙班組（55例）。對照組給予普通肝素1.25×104 U加生理鹽水配制成48 mL，2 mL/h, 24 h靜脈持續(xù)泵入，療程7 d；阿加曲班組患者開始2 d，阿加曲班注射液40 mg以適當(dāng)生理鹽水配制成96 mL，以4 mL/h，24 h靜脈持續(xù)泵入，后5 d，阿加曲班注射液20 mg以適當(dāng)生理鹽水配制成48 mL，2 mL/h，24 h靜脈持續(xù)泵入，療程7 d；利伐沙班組予以利伐沙班片10 mg/d，口服，療程7 d。每日測量患者雙下肢周徑，監(jiān)測凝血功能，血、尿常規(guī)及大便潛血等實(shí)驗(yàn)室指標(biāo)，另外檢測用藥前和用藥第7日的D-二聚體水平并觀察患者有無出血傾向及出血。所有患者7 d后改為口服華法林治療3～6月，檢測INR值，調(diào)整華法林劑量，維持INR值于2.0～3.0。結(jié)果 經(jīng)過7 d治療后，阿加曲班組下肢腫脹緩解率為95%，利伐沙班組為89%，對照組為96%，3組比較無差異。用藥7 d后，3組D-二聚體水平變化差異無統(tǒng)計學(xué)意義。阿加曲班組、利伐沙班組出血不良反應(yīng)發(fā)生率低于對照組（P＜0.05）。結(jié)論 阿加曲班和利伐沙班作為新型抗凝藥物，其臨床療效與傳統(tǒng)抗凝藥物普通肝素相比無明顯差異，但阿加曲班相比于普通肝素出血等不良反應(yīng)較少，同時，不會引起患者血小板減少。

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.