Clinical study on the diagnostic value of left atrial anterior posterior diameter combined with red blood cell volume distribution width for the stability of warfarin anticoagulation in elderly patients
Objective:To explore the diagnostic and predictive value of left atrial anterior posterior diameter com-bined with red blood cell volume distribution width for the stability of warfarin anticoagulation.Methods:All 143 pa-tients who received anticoagulation treatment with warfarin and had complete follow-up data from June 2021 to June 2023 were selected as the study subjects.Firstly,all study subjects were divided into a high-quality anticoagulant sta-bility group and a non high-quality anticoagulant stability group based on whether the anticoagulation stability(TTR)was≥70%.The differences and similarities between the two groups in terms of gender,age,comorbidities,hematologi-cal examination,and color ultrasound examination were compared,and conduct correlation analysis and binary logistic regression analysis on relevant indicators to explore possible factors that may affect TTR.Then,select the most correla-ted influencing factor in color ultrasound and compare and analyze it with the influencing factors in hematological exam-ination.Conduct separate and combined predictive value evaluations.Results:The comparison of activated partial throm-bin time(APTT),white blood cells(WBC),red blood cells(RBC),platelet distribution width(PDW),mean platelet volume(MPV),red blood cell volume distribution width(RDW),lipoprotein a[Lp(a)],left atrial anteroposterior di-ameter(LA-APD),right atrial ascending and descending diameter(RA-VD),left ventricular end systolic diameter(LVDs)and stroke output(SV)between the high-quality and non high-quality groups of warfarin anticoagulant sta-bility showed statistically significant differences(P＜0.05).Prothrombin time(PT),APTT,hemoglobin(Hb),RDW,LA-APD,left atrial up-and-down diameter(LA-VD),RA-VD and LVDs are the influencing factors of the anti-coagulation quality of warfarin.The AUC for Hb diagnosis of high-quality anticoagulation with warfarin is 0.676(95%CI:0.587～0.766),with sensitivity and specificity of 0.788 and 0.560,respectively.The Jordan index is 0.348,and the corresponding optimal cutoff value is 124%.The AUC for diagnosing high-quality anticoagulation with warfa-rin by RDW is 0.640(95%CI:0.545～0.735),with sensitivity and specificity of 0.538 and 0.725,respectively.The Jordan index is 0.263,and the corresponding optimal cutoff value is 13.95%.The AUC for LA-APD diagnosis of high-quality anticoagulation with warfarin is 0.867(95%CI:0.803～0.932),with sensitivity and specificity of 0.904 and 0.813,respectively.The Jordan index is 0.717,and the corresponding optimal cutoff value is 36.5%.The AUC of LA-APD combined with Hb for diagnosing high-quality anticoagulation with warfarin is 0.882(95%CI:0.821～0.942),with sensi-tivity and specificity of 0.885 and 0.857,respectively.The Jordan index is 0.742,and the corresponding optimal cutoff value is 0.464.The combination of LA-APD and RDW for diagnosing high-quality AUC of warfarin anticoagulation is 0.889(95%CI:0.831～0.947),with sensitivity and specificity of 0.923 and 0.813,respectively.The Jordan index is 0.736,and the corresponding optimal cutoff value is 0.346%.Conclusion:The predictive diagnostic value of left atrial anterior posterior diameter combined with red blood cell volume distribution width for the stability of warfarin anticoag-ulation is good.
left atrial anterior posterior diameterred blood cell volume distribution widthwarfarintime within therapeutic rangediagnostic value
维普
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