摘要目的:比较利伐沙班与低分子肝素治疗老年人恶性肿瘤并发静脉血栓栓塞症(VTE)的临床效果。方法:选取枝江市人民医院2016年1月至2019年3月收治的老年恶性肿瘤并发VTE患者88例，采用随机数字表法分为观察组、对照组各44例，对照组采用低分子肝素治疗，观察组采用利伐沙班治疗，两组均连续治疗3个月。比较两组治疗效果、治疗前后凝血功能变化及不良事件发生情况。结果:观察组疾病控制率88.64%(39/44)，高于对照组的84.09%(37/44)，但差异无统计学意义( P>0.05)。治疗后，观察组纤维蛋白原、D-二聚体、凝血酶原时间、活化部分凝血活酶时间分别为(3.22±0.53)g/L、(1.62±0.53)mg/L、(16.35±3.21)s、(39.22±9.03)s，对照组分别为(3.43±0.59)g/L、(1.73±0.56)mg/L、(15.73±3.24)s、(39.01±9.04)s，两组均较治疗前改善(观察组： t＝18.141、7.243、11.432、4.154，对照组： t＝15.191、5.925、10.357、4.034，均 P<0.05)，但两组差异均无统计学意义(均 P>0.05)。观察组不良事件发生率为9.09%(4/44)，低于对照组的25.00%(11/44)，两组差异有统计学意义(χ 2＝3.938， P<0.05)。 结论:利伐沙班与低分子肝素治疗老年人恶性肿瘤并发VTE疗效相当，均能改善患者凝血功能，但利伐沙班治疗期间出血及复发的不良事件发生率较低，安全性更高。

abstractsObjective:To compare the clinical effects of rivaroxaban and low molecular weight heparin in the treatment of malignant tumor complicated with venous thromboembolism(VTE) in the elderly.Methods:From January 2016 to March 2019, 88 patients with malignant tumor complicated with VTE treated in Zhijiang People's Hospital were divided into observation group and control group according to the random digital table method, with 44 patients in each group.The control group was treated with low molecular weight heparin, while the observation group was treated with rivaroxaban.Each group was treated continuously for 3 months.The therapeutic effect, change of coagulation function and occurrence of adverse events were compared between the two groups.Results:The disease control rate of the observation group[88.64%(39/44)] was higher than that of the control group[84.09%(37/44)], but the difference was not statistically significant( P>0.05). Compared with before treatment, the fibrinogen, D-dimer, prothrombin time and activated partial thromboplastin time in the observation group were (3.22±0.53)g/L, (1.62±0.53)mg/L, (16.35±3.21)s, (39.22±9.03)s, respectively, which in the control group were (3.43±0.59)g/L, (1.73±0.56)mg/L, (15.73±3.24)s, (39.01±9.04)s, respectively, which in the two groups were all improved after treatment (the observation group: t=18.141, 7.243, 11.432, 4.154; the control group: t=15.191, 5.925, 10.357, 4.034, all P<0.05), but there were no statistically significant differences between the two groups(all P>0.05). The incidence of adverse events in the observation group was 9.09%(4/44), which was lower than that in the control group [25.00%(11/44)], the difference between the two groups was statistically significant(χ 2=3.938, P<0.05). Conclusion:Rivaroxaban and low molecular weight heparin in the treatment of malignant tumor complicated with VTE in the elderly has similar effects, which can improve the coagulation function, while the incidence rate of bleeding and recurrence during rivaroxaban treatment is lower and the safety is higher.