凝血相关指标预测老年静脉血栓栓塞患者利伐沙班抗凝治疗安全性的研究  

A study on predicting the safety of rivaroxaban anticoagulant therapy in elderly patients with venous thromboembolism using coagulation related indicators

作　　者：李传华 LI Chuan-hua(Department of Laboratory,Yishui County People's Hospital,Linyi 276400,China)

机构地区：[1]沂水县人民医院检验科,276400

出　　处：《中国实用医药》2024年第13期11-15,共5页China Practical Medicine

摘　　要：目的 探讨凝血相关指标预测老年静脉血栓栓塞症(VTE)患者利伐沙班抗凝治疗安全性的临床价值。方法 118例老年VTE患者为研究对象,所有患者均采取利伐沙班抗凝治疗,检测患者凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、D-二聚体(D-D)、纤维蛋白原(FIB)、国际标准化比值(INR)]水平,比较患者治疗前后凝血指标PT、APTT、TT、D-D、FIB、INR水平,统计患者治疗期间出血事件发生情况;将治疗期间出现出血事件的患者作为出血组,未出现出血事件的患者作为未出血组,比较出血组和未出血组患者入院时PT、APTT、TT、D-D、FIB、INR水平;采用多因素回归分析患者发生出血事件的危险因素;利用受试者工作特征曲线(ROC)对各个凝血指标预测患者出血风险的效能进行评价。结果 治疗后,患者PT、APTT、INR水平分别为(13.52±1.99)s、(31.59±2.85)s、(1.21±0.24),较治疗前的(11.21±1.85)s、(27.59±2.18)s、(0.95±0.19)明显增加,差异均有统计学意义(P<0.05);患者治疗前后TT、D-D、FIB水平比较无明显差异(P>0.05)。治疗期间对患者进行随访, 118例患者中有28例出现出血事件,发生率为23.73%(28/118)。出血组患者PT、APTT分别为(14.25±2.05)、(30.58±2.11)s,均明显长于未出血组的(10.26±1.85)、(26.66±2.48)s,差异均有统计学意义(P<0.05);两组TT、D-D、FIB、INR水平比较无明显差异(P>0.05)。多因素Logistic回归分析显示:PT、APTT长是患者出现出血事件的独立危险因素(P<0.05)。ROC曲线分析显示:PT、APTT单独预测患者出血事件发生的曲线下面积(AUC)分别为0.793、0.773,两项指标联合预测的AUC为0.811, PT、APTT单独及联合预测的AUC比较无明显差异(P>0.05)。结论 PT、APTT能够监测老年VTE患者利伐沙班抗凝治疗效果,且对患者抗凝治疗期间出血风险具有较高的预测价值。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(

关 键 词：凝血 静脉血栓栓塞症 利伐沙班 出血 

分 类 号：R543.6[医药卫生—心血管疾病]