目的 探討阿司匹林與利伐沙班預防全膝關節(jié)置換后下肢深靜脈血栓（DVT）的療效。方法 選取200例需行全膝關節(jié)置換術的患者，隨機分為兩組，阿司匹林組（98例）術后12 h開始口服阿司匹林，利伐沙班組（102例）術后12 h開始口服利伐沙班，通過術前術后凝血指標、D-二聚體水平及圍手術期并發(fā)癥發(fā)生情況，評價阿司匹林與利伐沙班預防全膝關節(jié)置換后下肢DVT的療效。結果 術前，兩組各項凝血指標相比，差異沒有統(tǒng)計學意義。術后3d，兩組血小板值（Plt）、活化部分凝血活酶時間（APTT）、凝血酶原時間（PT）與術前相比，差異沒有統(tǒng)計學意義。阿司匹林組纖維蛋白原（FIB）水平明顯升高（P<0.05），高于利伐沙班組，而利伐沙班組FIB水平接近術前正常水平。術前兩組D-二聚體數值相比，差異無統(tǒng)計學意義；與術前相比，術后1、3、7d，兩組D-二聚體數值明顯上升（P<0.05），但術后3d和術后7d兩組D-二聚體數值開始出現下降趨勢。此外，術后1、3、7d利伐沙班組患者體內D-二聚體數值低于同時期阿司匹林組（P<0.05）。圍手術期兩組DVT發(fā)生率相比，差異無統(tǒng)計學意義。結論 利伐沙班可以有效預防全膝關節(jié)置換后下肢深靜脈血栓的形成，降低體內D-二聚體的水平，抗凝效果好且用藥安全性較高，值得臨床推廣使用。

Objective To compare the efficacy of aspirin and rivaroxaban on prevention of deep vein thrombosis after total knee repalcement. Methods Patients (200 cases) who were given total knee replacement were selected, and the patients in aspirin group(98 cases) were administered with asprin after 12 h treatment, and the patients in rivaroxaban group(102 cases) were administered with rivaroxaban after 12 h treatment. The efficacy of aspirin and rivaroxaban to prevent deep vein thrombosis after total knee repalcement was evaluated by blood coagulation indexes, D-dimer level, and complication during perioperative period. Results Before surgery, there was no statistically significant difference on coagulation indexes between two groups. After 3 d of operation, there was no statistically significant difference in Plt, APTT, and PT between two groups. The FIB level of aspirin group was improved significantly and higher than that of rivaroxaban group(P<0.05). While the FIB level of rivaroxaban group was close to the normal level. Before operation, there was no statistically significant difference in D-dimer between two groups. After 1, 3, and 7 d of operation, the D-dimer levels in two groups were increased. But the D-dimer levels of 3 and 7 d after operation began to decline. After 1, 3, and 7 d of operation, the D-dimer of rivaroxaban group was lower than that of aspirin group(P<0.05). During perioperative period, there was no statistically significant difference on DVT between two groups. Conclusion Rivaroxaban could prevent the formation of DVT effectively and reduce the D-dimer with good anticoagulation and high safety. It is worthy of clinical application.