| Objective:To observe the clinical outcomes of anti-Xa activity by monitoring plasma anti-Xa activity and adjusting the dose of anticoagulants in patients with acute pulmonary thromboembolism(PTE)according to anti-Xa activity.Method:This study was a single-center retrospective study.Patients with acute PTE in Shenzhen People’s Hospital from January 2020 to October 2021 were included,and information on general condition,clinical regression,bleeding events during anticoagulation,laboratory test results,pulmonary vascular imaging and cardiac ultrasound findings were collected.In this study,163 patients with acute PTE were enrolled,81 men and 82 women,with a mean age of 58 years.Eighty cases(49%)were enrolled in the anti-Xa activity concentration monitoring group,41 cases(51.3%)in men and 39 cases(48.7%)in women,with a mean age of 57 years.64 cases(80%)achieved peak anti-Xa activity concentration,7 cases(8.8%)in the anti-Xa activity peak concentration supertherapeutic level group,9 cases(11.2%)in the anti-Xa activity peak concentration subtherapeutic level group,and 30 cases(37.5%)achieved the anti-Xa activity trough concentration,50 cases(62.5%)with supertherapeutic level of anti-Xa activity valley concentration,covering 34 cases(42.5%)in special populations,including 9 cases(11.3%)in the elderly,4 cases(5.0%)in the low weight,10 cases(12.5%)in the obese,14 cases(17.5%)in the malignant tumor and 10cases(12.5%)in the renal insufficiency populations,respectively.Eighty-three cases(51%)were included in the non-monitoring group,40 cases(48.2%)in men and 43 cases(51.8%)in women,with a mean age of 59 years,including 41 cases(49.4%)in special populations,12 cases(14.5%)in the elderly,4 cases(4.8%)in the low weight group,13 cases(15.7%)in the obese group,12 cases(14.5%)in the malignant tumor group,and 14 cases(15.7%)in the renal insufficiency group,respectively.The relationship between anti-Xa activityguided anticoagulant dose adjustment and clinical outcomes was analyzed using SPSS13.0.Results:(1)In comparison with non-monitoring groups,the degree of improvement in oxygen saturation and oxygenation index was higher in monitoring group at 2 weeks of anticoagulation and the decrease in pulmonary artery systolic pressure was greater in monitoring group at 3 months of anticoagulation(P values 0.018,0.013,0.017,respectively).(2)Comparison of clinical outcomes between groups with different levels of anti-Xa activity:1)At 2 weeks of anticoagulation,the degree of improvement in oxygenation index was lower in the subtherapeutic level group with peak anti-Xa activity than in the attainment group(P=0.005)and the supertherapeutic level group(P=0.008),the degree of improvement in oxygen saturation was lower in the trough concentration attainment group than in the supertherapeutic level group(P=0.040),and the degree of improvement in oxygenation index was lower in the trough concentration attainment group than in the supertherapeutic level group(P=0.016).2)At 2 weeks of anticoagulation,thrombus uptake in the peak anti-Xa activity concentration subtherapeutic level group was lower than the attainment group(P=0.048)and was an independent risk factor for thrombus uptake outcome at 2weeks of anticoagulation(P=0.002,OR 0.075,95% CI 0.014~0.391).3)The differences in the magnitude of decrease in pulmonary artery systolic pressure and improvement in right ventricular dilatation at different levels of peak and trough concentrations of anti-Xa activity at 3 months of anticoagulation were not statistically significant.4)Bleeding during anticoagulation was higher in the group with peak anti-Xa activity concentration over therapeutic levels than in the group with attainment(P<0.001)and subtherapeutic levels(P=0.032),with no statistically significant differences in bleeding between groups with different levels of trough concentrations.Peak concentration of anti-Xa activity beyond the therapeutic level was an independent risk factor for bleeding events during anticoagulation(OR 23.621,95% CI 2.593 to 215.165,P=0.005).(3)Comparison of bleeding in special and non-special populations :1)Bleeding during anticoagulation was lower in the monitoring group than in the non-monitoring group in the elderly population(P=0.007)and lower in the monitoring group than in the non-monitoring group in the population with renal insufficiency(P=0.031).There was no statistically significant difference in bleeding between the monitored and non-monitored groups in the low weight,obese and malignant populations.2)Bleeding during anticoagulation was higher in the group with peak anti-Xa activity concentrations above therapeutic levels than in the attainment group in the obese population(P=0.028).There was no statistically significant difference in bleeding events between the attainment group and the supratherapeutic level group in the elderly,low weight,malignancy and renal insufficiency populations.There was no statistically significant difference in bleeding events between the group with attained peak concentration of anti-Xa activity and the group with supra-therapeutic levels in the elderly,obese,low weight,malignant tumor and renal insufficiency populations.3)There was no statistically significant difference in bleeding between the groups with different levels of peak concentration of anti-Xa activity and no statistically significant difference in bleeding between the groups with different levels of trough concentration in the non-specialized populations.Discussion:(1)Compared with the non-monitoring group,monitoring of anti-Xa activity concentration was more beneficial to improve oxygenation index and oxygen saturation at 2 weeks of anticoagulation,reduce the risk of bleeding in the elderly and renal insufficiency,and reduce the level of pulmonary artery systolic pressure at 3 months of anticoagulation.(2)Anticoagulation for 2 weeks with peak anti-Xa activity concentration at and beyond therapeutic levels and trough concentration beyond therapeutic levels promotes improvement in oxygenation index and oxygen saturation,and peak antiXa activity concentration at facilitates the absorption of pulmonary artery thrombus.(3)The risk of bleeding during anticoagulation at peak anti-Xa activity concentrations beyond therapeutic levels was significantly increased and was more pronounced in the obese population. |
PDF Full Text Request