摘要目的:探讨因下肢深静脉血栓口服利伐沙班患者出现上消化道出血后，恢复利伐沙班的时机。方法:回顾性分析河北医科大学第三医院2018年5月至2021年10月收治的因外伤或手术等原因出现下肢深静脉血栓，口服利伐沙班出现上消化出血患者176例的临床资料。根据出血后恢复利伐沙班时间分为早期组（≤ 7 d）（84例）和晚期组（> 7 d）（92例）。随访观察2个月，记录血红蛋白、D-二聚体、血小板数值，观察下肢深静脉血栓进展情况，分析两组再出血率、下肢深静脉血栓进展情况、病死率等。结果:两组入院时血红蛋白、D-二聚体水平比较，差异均无统计学意义（均 P > 0.05）。入院后晚期组D-二聚体最高水平［（4.1±2.3）mg/L］显著高于早期组［（3.1±1.9）mg/L］（ t=3.17， P < 0.05）；两组血红蛋白水平较入院时均下降（均 P < 0.05），晚期组血红蛋白最低值［（78.7±8.3）g/L］显著高于早期组［（75.6±8.2）g/L］（ t=2.32， P < 0.05）。早期组再出血［5.95%（5/84）］与晚期组［1.08%（1/92）］比较，差异无统计学意义（log-rank为3.07， P > 0.05），早期组下肢血栓出现进展［2.38%（2/84）］显著低于晚期组［10.86%（10/92）］（log-rank为4.61， P < 0.05）。 结论:存在下肢深静脉血栓口服利伐沙班的患者发生上消化道出血后，应尽早恢复利伐沙班治疗。

abstractsObjective:To investigate the timing of rivaroxaban re-administration after upper gastrointestinal bleeding in patients with lower extremity deep venous thrombosis.Methods:The clinical data of 176 patients who suffered from lower limb deep vein thrombosis due to trauma or surgery and upper gastrointestinal bleeding due to oral rivaroxaban and received treatment in the Third Hospital of Hebei Medical University from May 2018 to October 2021 were retrospectively analyzed. These patients were divided into an early group (≤ 7 days) ( n = 84 cases) and a late group (> 7 days) ( n = 92 cases) according to the timing of rivaroxaban re-administration. All patients were followed up for 2 months to record hemoglobin, D-dimer, and platelet values. The progression of deep venous thrombosis of the lower extremities was observed. The rebleeding rate, progression of lower extremity deep venous thrombosis, and mortality were analyzed. Results:There were no significant differences in hemoglobin and D-dimer levels between the two groups on admission (both P > 0.05). After admission, the D-dimer level in the late group was (4.1 ± 2.3) mg/L, which was significantly higher than (3.1 ± 1.9) mg/L in the early group ( t = 3.17, P < 0.05). After admission, hemoglobin level in each group was significantly decreased compared with that on admission (both P < 0.05). The lowest hemoglobin level in the late group was (78.7 ± 8.3) g/L, which was significantly higher than (75.6 ± 8.2) g/L in the early group ( t = 2.32, P < 0.05). There was no significant difference in rebleeding rate between early and late groups [5.95% (5/84) vs. 1.08% (1/92)] (log-rank 3.07, P > 0.05). Lower extremity deep venous thrombosis progressed more slowly in the early group compared with the late group [2.38% (2/84) vs. 10.86% (10/92)] (log-rank = 4.61, P < 0.05). Conclusion:Rivaroxaban should be re-administered as soon as possible after upper gastrointestinal bleeding in patients with lower extremity deep venous thrombosis.