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

doi:10.3969/j.issn.1673-8640.2023.05.012

检验医学 ›› 2023, Vol. 38 ›› Issue (5): 475-478.DOI: 10.3969/j.issn.1673-8640.2023.05.012

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

夏艳艳, 夏永泉, 宋广浩, 夏茂()

南京大学医学院附属鼓楼医院，江苏南京 210008

收稿日期:2022-04-21 修回日期:2022-07-04 出版日期:2023-05-30 发布日期:2023-08-07
通讯作者: 夏茂， E-mail：843731079@qq.com。
作者简介:夏艳艳，女，1986年生，硕士，主管技师，主要从事血栓与止血研究。
基金资助:
国家自然科学基金面上项目(82073367)

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

XIA Yanyan, XIA Yongquan, SONG Guanghao, XIA Mao()

Drum Tower Hospital，Nanjing University Medical School，Nanjing 210008，Jiangsu，China

Received:2022-04-21 Revised:2022-07-04 Online:2023-05-30 Published:2023-08-07

摘要/Abstract

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。

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

Abstract:

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-factor Ⅹa 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-factor Ⅹa 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，Ⅺ and Ⅻ） 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.

Key words: Rivaroxaban, Acute venous thromboembolism, Anti-factor Ⅹa, Coagulation routine test, Coagulation factor

中图分类号:

R446.11

夏艳艳, 夏永泉, 宋广浩, 夏茂. 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[J]. 检验医学, 2023, 38(5): 475-478.

XIA Yanyan, XIA Yongquan, SONG Guanghao, XIA Mao. Role of coagulation-related monitoring indicators in the course of rivaroxaban anticoagulation for acute venous thromboembolism in elderly patients[J]. Laboratory Medicine, 2023, 38(5): 475-478.

图/表 4

参考文献 17

[1]	蔡亮, 丁勇, 周旻, 等. 利伐沙班与传统抗凝药物在80岁以上静脉血栓栓塞症患者中的有效性与安全性对比[J]. 中国临床医学, 2019, 26(2):272-276.
[2]	王乔宇, 武明芬, 柳鑫, 等. 2021中国静脉血栓栓塞症防治抗凝药物的选用与药学监护指南[J]. 中国临床药理学杂志, 2021, 37(21):2999-3016.
[3]	TAGALAKIS V, PATENAUDE V, KAHN S R, et al. Incidence of and mortality from venous thromboembolism in a real-world population:the Q-VTE study cohort[J]. Am J Med, 2013, 126(9):832.e13-832.e 21. DOI URL
[4]	王兆钺. 静脉血栓栓塞治疗的具体临床应用及有关的问题[J]. 血栓与止血学, 2019, 25(2):181-184.
[5]	KHAN F, TRITSCHLER T, KAHN S R, et al. Venous thromboembolism[J]. Lancet, 2021, 398(10294):64-77. DOI PMID
[6]	徐宁, 赵怡. 利伐沙班在老年全膝关节置换术后预防下肢深静脉血栓的效果[J]. 中华老年多器官疾病杂志, 2020, 19(9):686-689.
[7]	STEVENS H, MCFADYEN J, CHAN N. Advances in the management of acute venous thromboembolism and new therapeutic agents[J]. Semin Respir Crit Care Med, 2021, 42(2):218-232. DOI PMID
[8]	ZHANG X, CAI Q, WANG X, et al. Current use of rivaroxaban in elderly patients with venous thromboembolism(VTE)[J]. J Thromb Thrombolysis, 2021, 52(3):863-871. DOI
[9]	王蓓, 曹素艳, 王雁, 等. 老年肿瘤患者合并静脉血栓栓塞症的临床调查[J]. 中华老年医学杂志, 2007, 26(6):426-428.
[10]	HU B, JIANG L, TANG H, et al. Rivaroxaban versus aspirin in prevention of venous thromboembolism following total joint arthroplasty or hip fracture surgery:a meta-analysis[J]. J Orthop Surg Res, 2021, 16(1):135. DOI
[11]	WATTS P J, KOPSTEIN M, HARKNESS W, et al. A retrospective analysis of bleeding risk with rivaroxaban,enoxaparin,and aspirin following total joint arthroplasty or revision[J]. Pharmacotherapy, 2021, 41(7):608-615. DOI URL
[12]	杨霞, 董淑杰, 翟所迪. 利伐沙班治疗深静脉血栓有效性和安全性的Meta分析[J]. 中国药学杂志, 2017, 52(21):1948-1952.
[13]	左丽, 邢惟青, 王茜, 等. 利伐沙班致严重胃肠道出血死亡病例分析[J]. 中国临床药理学杂志, 2019, 35(6):571-572.
[14]	FRANCART S J, HAWES E M, DEAL A M, et al. Performance of coagulation tests in patients on therapeutic doses of rivaroxaban. A cross-sectional pharmacodynamic study based on peak and trough plasma levels[J]. Thromb Haemost, 2014, 111(6):1133-1140. DOI URL
[15]	SAMAMA M M, CONTANT G, SPIRO T E, et al. Evaluation of the prothrombin time for measuring rivaroxaban plasma concentrations using calibrators and controls:results of a multicenter field trial[J]. Clin Appl Thromb Hemost, 2012, 18(2):150-158. DOI URL
[16]	DALE B J, GINSBERG J S, JOHNSTON M, et al. Comparison of the effects of apixaban and rivaroxaban on prothrombin and activated partial thromboplastin times using various reagents[J]. J Thromb Haemost, 2014, 12(11):1810-1815. DOI PMID
[17]	徐彬彬. 利伐沙班对家兔凝血功能的影响及机制初步探讨[D]. 苏州: 苏州大学, 2016.

项目	PT /s	INR	APTT /s	TT /s	Fib/（g/L）	DD /（mg/L）	FDP /（mg/L）	AT3 /%
服药前	11.13±2.06	0.97±0.16	28.00±2.64	18.35±2.70	4.03±1.05	0.64±0.28	3.45±1.24	106.93±20.14
服药后	13.48±1.55	1.18±0.15	32.89±3.74	18.38±3.09	3.77±1.24	0.62±0.23	3.53±0.97	101.89±21.46
P值	<0.01	<0.01	<0.01	>0.05	>0.05	>0.05	>0.05	>0.05

项目	PT /s	INR	APTT /s	TT /s	Fib/（g/L）	DD /（mg/L）	FDP /（mg/L）	AT3 /%
服药前	11.13±2.06	0.97±0.16	28.00±2.64	18.35±2.70	4.03±1.05	0.64±0.28	3.45±1.24	106.93±20.14
服药后	13.48±1.55	1.18±0.15	32.89±3.74	18.38±3.09	3.77±1.24	0.62±0.23	3.53±0.97	101.89±21.46
P值	<0.01	<0.01	<0.01	>0.05	>0.05	>0.05	>0.05	>0.05

项目	凝血因子Ⅱ	凝血因子Ⅴ	凝血因子Ⅶ	凝血因子Ⅷ	凝血因子Ⅸ	凝血因子Ⅹ
服药前	95.11±22.43	132.43±29.54	116.98±39.84	226.37±87.07	116.71±35.73	94.43±23.20
服药后	82.84±17.00	104.76±33.70	93.82±26.95	156.59±33.06	77.98±21.24	78.31±14.26
P值	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01
项目		凝血因子Ⅺ	凝血因子Ⅻ	蛋白C	蛋白S	VWF
服药前		100.87±46.17	51.77±15.93	102.98±15.05	136.95±44.75	237.89±42.21
服药后		61.98±10.79	37.46±9.05	99.70±12.83	138.01±31.83	242.55±28.22
P值		<0.01	<0.01	>0.05	>0.05	>0.05

项目	凝血因子Ⅱ	凝血因子Ⅴ	凝血因子Ⅶ	凝血因子Ⅷ	凝血因子Ⅸ	凝血因子Ⅹ
服药前	95.11±22.43	132.43±29.54	116.98±39.84	226.37±87.07	116.71±35.73	94.43±23.20
服药后	82.84±17.00	104.76±33.70	93.82±26.95	156.59±33.06	77.98±21.24	78.31±14.26
P值	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01
项目		凝血因子Ⅺ	凝血因子Ⅻ	蛋白C	蛋白S	VWF
服药前		100.87±46.17	51.77±15.93	102.98±15.05	136.95±44.75	237.89±42.21
服药后		61.98±10.79	37.46±9.05	99.70±12.83	138.01±31.83	242.55±28.22
P值		<0.01	<0.01	>0.05	>0.05	>0.05

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

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