Analysis Of The Efficacy Of Rivaroxaban In Preventing Thrombosis After Iliac Vein Stenting

Objective:To compare the Factor Xa inhibitor,Rivaroxaban,and Warfarin plus aspirin in effect difference of iliac venous thromboembolism prophylaxis after stent implantation,To evaluate the application value of rivaroxaban in preventing stent thrombosis in iliac vein.To search for a safer and more effective thrombosis prevention scheme for patients after iliac vein stenting.Methods:A retrospective analysis was made of 61 patients with iliac vein compression syndrome treated with stents in the First Affiliated Hospital of Zhengzhou University from January 2014 to June 2016.They were divided into rivaroxaban group（experimental group）and traditional anticoagulant group（warfarin+aspirin group）（control group）.Both groups were treated with elastic socks or bandage compression after operation.Low molecular weight heparin（LWMH）was administered to prevent thrombosis during hospitalization for 100U·kg^-1 q12h.After discharge,the experimental group was adjusted to rivaroxaban with 20mg qd,the control group was given warfarin plus aspirin after adjusting the standard of warfarin（inr2-3）,regular monitoring of blood coagulation function,and maintained this standard.Both groups were given the same promoting blood circulation and antiswelling drugs,and the anticoagulation time was 6 months.The stent patency was observed by ultrasound or venography in 1 month,3 months,6 months,1 year and 2 years after operation.Meanwhile,evaluate venous function and record adverse events such as bleeding.Results:After 2 years of follow-up,the incidence of stent thrombosis was 12.50%in the experimental group and 16.21%in the control group,with no statistically significant difference（P>0.05）.The primary patency rate was 100%,95.8%,91.7%,91.7%and87.5%in the experimental group at 1,3,6,12 and 24 months after surgery,respectively.The secondary patency rate was 100%,100%,95.8%,95.8%and 95.8%,respectively.In the control group,the primary patency rate was 97.3%,94.6%,89.2%,89.2%,83.8%,and the secondary patency rate was 100%,97%,97%,94.6%,94.6%,at 1,3,6,12 and24 months after surgery,respectively.There was no significant difference between the two groups（P>0.05）.There was no significant difference in VCSS score between the two groups with CVI and PTS（P>0.05）.VCSS scores of patients with acute thrombosis were significantly different between the two groups（P<0.05）.Bleeding events compared two groups,experimental group total 8 cases of bleeding,including the hemorrhage of skin,mucosa and gingiva in 3 cases（12.5%）,gross hematuria in 1 case（4.17%）,4 cases（16.67%）of gastrointestinal bleeding,control group total of 17 cases of bleeding,hemorrhage of skin,mucosa and gingiva in 5 cases（13.51%）,gross hematuria in 2 cases（5.41%）,gastrointestinal bleeding in 2 cases（5.41%）,8cases（21.6%）of severe intracranial and retroperitoneal hemorrhage.Conclusion:1.The results of this study showed that rivaroxaban had no significant difference in the prevention of iliac vein stent thrombosis compared with warfarin combined with aspirin regimen.2.For patients with deep venous thrombosis after stent implantation,the VCSS score after rivaroxaban treatment was lower,and there was no significant difference in VCSS score between patients with CVI and PTS.These results suggest that rivaroxaban has a better prognosis in patients with acute deep venous thrombosis before stent implantation.3.Compared with warfarin combined with aspirin regimen,Rivaroxaban has no significant difference in total bleeding risk,but Rivaroxaban has lower risk of severe intracranial and retroperitoneal bleeding.Moreover,rivaroxaban is convenient to administer and does not need to monitor INR,which indicates that rivaroxaban is a safer and more convenient drug regimen.