A study on predicting the safety of rivaroxaban anticoagulant therapy in elderly patients with venous thromboembolism using coagulation related indicators
Objective To explore the clinical value of coagulation related indicators in predicting the safety of rivaroxaban anticoagulation therapy in elderly patients with venous thromboembolism(VTE).Methods A total of 118 elderly patients with VTE were studied.All patients were treated with rivaroxaban anticoagulant therapy.The levels of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),D-dimer(D-D),fibrinogen(FIB),and international standardized ratio(INR)of the patients were detected.The levels of coagulation indexes PT,APTT,TT,D-D,FIB and INR were compared before and after treatment,and the occurrence of bleeding events during treatment was counted.Patients with bleeding events during treatment were selected as the bleeding group and those without bleeding events as the non-bleeding group.The levels of PT,APTT,TT,D-D,FIB and INR were compared between the bleeding group and the non-bleeding group at admission.Multivariate regression was used to analyze the risk factors of bleeding events.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of each coagulation index in predicting the bleeding risk of patients.Results After treatment,the levels of PT,APTT and INR were(13.52±1.99)s,(31.59±2.85)s and(1.21±0.24),which were significantly increased compared with those of(11.21±1.85)s,(27.59±2.18)s,and(0.95±0.19)before treatment,and the difference was statistically significant(P<0.05).There was no significant difference in the comparison of TT,D-D,and FIB levels before and after treatment(P>0.05).Patients were followed up during the treatment period,and bleeding events occurred in 28 of 118 patients,with an incidence rate of 23.73%(28/118).PT and APTT of patients in the bleeding group were(14.25±2.05)and(30.58±2.11)s,which were significantly longer than(10.26±1.85)and(26.66±2.48)s in the non-bleeding group,and the difference was statistically significant(P<0.05).There was no significant difference between the levels of TT,D-D,FIB and INR between the two groups(P>0.05).Multivariate Logistic regression analysis showed that long PT and APTT were independent risk factors for the development of bleeding events(P<0.05).ROC curve analysis showed that the area under the curve(AUC)predicted by PT and APTT alone was 0.793 and 0.773,respectively,and the AUC predicted by the two indexes combined was 0.811.There was no significant difference(P>0.05)in the prediction of AUC between PT and APTT alone and in combination(P>0.05).Conclusion PT and APTT indicators can monitor the effectiveness of rivaroxaban anticoagulation therapy in elderly VTE patients,and have high predictive value for bleeding risk during anticoagulation therapy.
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