凝血相关指标在老年静脉血栓栓塞患者利伐沙班抗凝治疗监测中的价值  

Role of coagulation-related monitoring indicators in the course of rivaroxaban anticoagulation for acute venous thromboembolism in elderly patients

作　　者：夏艳艳 夏永泉[1] 宋广浩 夏茂 XIA Yanyan;XIA Yongquan;SONG Guanghao;XIA Mao(Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京大学医学院附属鼓楼医院,江苏南京210008

出　　处：《检验医学》2023年第5期475-478,共4页Laboratory Medicine

基　　金：国家自然科学基金面上项目(82073367)。

摘　　要：目的分析老年静脉血栓栓塞(VTE)患者口服利伐沙班后凝血相关指标的变化,寻找可以监测利伐沙班有效性和安全性的指标。方法选取2019年4月—2021年12月南京大学医学院附属鼓楼医院老年VTE患者50例,其中男21例、女29例,年龄(84.25±3.28)岁。给予利伐沙班口服10 mg,比较患者服药前后抗Ⅹa因子活性、凝血六项指标和凝血因子活性的变化。采用受试者工作特征(ROC)曲线评价相关指标预测患者出血风险的效能。结果与服用利伐沙班前相比,服用利伐沙班后VTE患者抗Ⅹa因子活性明显升高(P<0.01),凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)水平均明显延长(P<0.01),凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ、Ⅻ的活性均呈下降的趋势(P<0.01)。ROC曲线分析结果显示,PT对出血风险的预测能力中等(曲线下面积为0.81,95%可信区间为0.66~0.95),但优于其他凝血指标。结论PT可作为监测利伐沙班抗凝效果的指标,且对出血风险的预测能力较好。Objective To study the changes of coagulation-related monitoring indicators in elderly patients with acute venous thromboembolism(VTE)after taking rivaroxaban,and to investigate the appropriate indicators for monitoring the anticoagulation strength and safety of rivaroxaban.Methods Totally,50 elderly patients with acute venous thromboembolism,including 21 males and 29 females,aged(84.25±3.28)years,from Drum Tower Hospital of Nanjing University Medical School from April 2019 to December 2021,were enrolled.Rivaroxaban(10 mg)was administered orally to patients,and the changes on anti-factorⅩa activity,coagulation six indicators and coagulation factor activity for VTE patients were observed before and after dosing.Bleeding risk was predicted with related indicators using receiver operating characteristic(ROC)curve.Results Compared with those before taking rivaroxaban,anti-factorⅩa activity was higher(P<0.01),prothrombin time(PT),international normalized ratio(INR)and activated partial thromboplastin time(APTT)were higher(P<0.01),and the levels of coagulation factors(Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ,ⅪandⅫ)showed a decreasing trend(P<0.01).ROC curve analysis showed that PT was a moderate predictor of bleeding risk,and the area under curve was 0.81[95%confidence interval(CI)0.66-0.95].Conclusions PT can be used not only as a preliminary indicator for anticoagulation monitoring with rivaroxaban,but also it has high predictive role for bleeding risk.

关 键 词：利伐沙班 静脉血栓栓塞 抗Ⅹa因子 凝血常规 凝血因子活性 80岁人群 

分 类 号：R446.11[医药卫生—诊断学]