[Low molecular weight heparin combined with aspirin to prevent perioperative venous thromboembolism in patients with splenic rupture and lower extremity fracture].

To investigate the effectiveness and safety of low molecular weight heparin combined with aspirin for perioperative prophylactic anticoagulation in patients with lower extremity fracture after splenectomy.The clinical data of 50 patients with splenic rupture combined with lower extremity fracture between January 2009 and June 2022 were retrospectively analyzed. All patients were given enoxaparin sodium at 48 hours after splenectomy, and stopped at 24 hours before fracture surgery. After fracture surgery, the patients were divided into aspirin group (group A, 15 cases), low molecular weight heparin group (group B, 16 cases), and low molecular weight heparin combined with aspirin group (group C, 19 cases) according to different anticoagulation regimens. The treatment course was 28 days. There was no significant difference in gender, age, body mass index, cause of injury, fracture site, time from injury to operation, complications, and other general data between groups ( P>0.05). The occurrence of venous thromboembolism (VTE) was observed; hemoglobin (Hb), platelet (PLT), D-D dimer, and fibrinogen degradation product (FDP) were recorded before operation and at 1, 3, and 7 days after operation, and the effect of anticoagulation regimen on coagulation function was observed. The incidences of wound complications and bleeding related complications were recorded, and the total perioperative blood loss, hidden blood loss, and overt blood loss were calculated.The incidences of VTE in groups A, B, and C were 13.33% (2/15), 12.50% (2/16), and 5.26% (1/19), respectively, and there was no significant difference between groups ( χ2=0.770, P=0.680). There was no portal vein thrombosis and no VTE-related death in the 3 groups. There was no significant difference in the levels of Hb, PLT, D-D dimer, and FDP between groups before and after operation ( P>0.05); and there was no significant difference in total perioperative blood loss, hidden blood loss, and overt blood loss between groups ( P>0.05). No local skin necrosis was found in all patients. In group A, 1 case occurred redness and swelling of incision; in group B, 1 case had incision discharge, redness, and swelling, and 1 case had fat liquefaction; in group C, 1 case had repeated incision exudation accompanied by local tissue redness and swelling, and 1 case had local hematoma. The incidences of adverse incision in groups A, B, and C were 6.66% (1/15), 12.50% (2/16), and 11.76% (2/19), respectively, with no significant difference ( χ2=0.302, P=0.860). There were 4 cases of bleeding related complications, including 1 case of incision ecchymosis in groups A and B respectively, with the incidence of 6.66% and 6.25%, respectively; there was 1 case of incision hematoma and 1 case of bleeding in group C, with the incidence of 11.76%; showing no significant difference in the incidence of bleeding related complications between groups ( χ2=0.268, P=0.875).Perioperative combined use of low molecular weight heparin and aspirin for prevention of anticoagulation in patients with splenic rupture and lower extremity fracture can effectively prevent the occurrence of VTE without increasing the incidence of complications, which is an effective and safe treatment method. However, whether the incidence of VTE can be reduced needs to be further studied by expanding the sample size.探讨脾切除后下肢骨折手术患者围术期采用低分子肝素联合阿司匹林预防抗凝治疗的疗效及安全性。.回顾分析2009年1月—2022年6月收治的50例脾破裂合并下肢骨折患者临床资料。于脾切除术后48 h开始给予依诺肝素钠抗凝治疗，骨折手术前24 h停用；骨折手术后按抗凝方案不同分为阿司匹林组（A组，15例）、低分子肝素组（B组，16例）和低分子肝素联合阿司匹林组（C组，19例），疗程均为28 d。3组患者性别、年龄、身体质量指数、致伤原因、骨折部位、受伤至手术时间、合并症等一般资料比较差异均无统计学意义（ P>0.05）。观察患者静脉血栓栓塞（venous thromboembolism，VTE）发生情况；术前及术后1、3、7 d记录患者血红蛋白（hemoglobin，Hb）、血小板（platelet，PLT）、 D-D二聚体、纤维蛋白原降解产物（fibrinogen degradation product，FDP）水平，观察抗凝方案对患者凝血功能的影响；记录切口并发症及出血相关并发症发生情况，计算围术期失血总量、隐性失血量和显性失血量。.A、B、C组VTE发生率分别为13.33%（2/15）、12.50%（2/16）和5.26%（1/19），差异无统计学意义（ χ2=0.770， P=0.680）。3组患者均无门静脉血栓形成，均无VTE相关性死亡。3组患者手术前后各时间点Hb、PLT、D-D二聚体、FDP水平比较，差异均无统计学意义（ P>0.05）。3组患者术后显性失血量、隐性失血量及围术期失血总量比较差异亦无统计学意义（ P>0.05）。所有患者均无局部皮肤坏死，A组发生切口红肿1例；B组切口流脓、红肿1例，脂肪液化1例；C组切口渗出反复较多且伴有周围局部组织红肿1例，切口局部血肿1例。A、B、C组切口并发症发生率分别为6.66%（1/15）、12.50%（2/16）、11.76%（2/19），差异无统计学意义（ χ2=0.302， P=0.860）。4例发生出血并发症，其中A、B组各1例切口处瘀斑，发生率分别为6.66%和6.25%；C组发生切口血肿1例、出血事件1例，发生率为11.76%；3组间出血并发症发生率差异无统计学意义（ χ2=0.268， P=0.875）。.脾切除后下肢骨折手术患者围术期联合使用低分子肝素、阿司匹林预防抗凝治疗，能有效预防VTE发生，且不增加并发症发生率，是一种有效、安全的治疗方法；但能否降低VTE发生率有待扩大样本量进一步研究明确。.