Anticoagulation Efficacy And Safety Of Rivaroxaban And Warfarin In The Treatment Of Lower Extremity Deep Venous Thrombosis After Thrombolytic Therapy

Objective: Deep venous thrombosis(DVT)is due to slow venous blood flow in the blood vessels,vascular endothelial cell damage,blood hypercoagulable state and other conditions,resulting in blood coagulation in the deep vein caused by venous blood flow obstruction.DVT often lead to post thrombotic syndrome(PTS),which can lead to pulmonary embolism(PE)and also lead to lower extremities,easy to fall off early thrombosis,can enter the pulmonary artery with the blood circulation,causing pulmonary embolism.It complications are a serious threat to people's health and safety.Timely and effective removal of thrombosis can relieve symptoms,reduce or avoid the emergence of complications.Anticoagulation is a method of preventing and treating thrombotic diseases by reducing blood coagulation.At present the clinical commonly used anticoagulant drugs: unfractionated heparin,Low molecular weight heparin,Warfarin(vitamin k antagonist),Argatroban(direct factor II inhibitor),Rivaroxaban(direct Xa factor inhibitor),Fondaparinux sodium(indirect Xa inhibitor)and so on.Rivensabab as a new type of oral anticoagulant drugs in the orthopedic surgery after the application of rivaroxaban in the prevention of DVT and PE Phase II and Phase III clinical studies,which effect is significant.The incidence of bleeding events is low.In recent years,with the deepening of the study of rivaroxaban,in the lower extremity DVT anticoagulant therapy,compared with the traditional anticoagulant effect is significant.However,the anticoagulation efficacy and safety of long-term oral rivaroxaban in patients with thrombolytic therapy have not been reported.This study selected patients of lower extremity deep venous thrombosisafter thrombolysis,which were oral warfarin anticoagulant therapy and benefit of rivaroxaban,and to observe the clinical curative effect,safety,compliance and quality of life and other aspects,so as to clinical thrombolysis after use of anticoagulant drugs to provide the clinical basis for medication and reference more.Method:1 Collecting 50 cases of Vascular Surgery in Hebei Provincial People's Hospital from January 2016 to June 2016,the incidence of acute deep venous thrombosis in patients with inclusion criteria.The experiment scheme,postoperative anticoagulation treatment and follow-up methods were explained to the patient,and signed a consent form,were randomly divided into two groups: experimental group(25cases)treated with oral anticoagulation therapy for benefit of rivaroxaban;the control group(25 cases)with low molecular weight heparin bridging warfarin for anticoagulation therapy.Admission criteria:1)Patients with lower extremity DVT related symptoms,such as limb swelling,tenderness,pain,etc;2)Deep vein ultrasonography or deep vein angiography confirmed by deep vein thrombosis,and diagnosed as a single lower limb DVT;3)Acute central or mixed type DVT;4)Age of 75 years,the expected survival of more than 1 years;5)History <7 days,plasma D-dimer> 500 ug / L;6)After thrombolytic therapy angiography showed blood vessels have been smooth.Exclusion criteria:1)The presence of severe liver and kidney dysfunction;2)Pregnant or lactating women;3)In the past 2 weeks,patients with active bleeding or combined with a variety of blood diseases,affecting the coagulation function or anticoagulant taboo;4)Patients with mental illness;5)Due to brain disease(such as stroke;neurological disorders)affect the efficacy of analysts;6)Recent major surgery or larger trauma,need to stop or suspected of internal bleeding;7)Patients without hypertension;8)Contrast agent allergy;2 Thrombolytic therapyThe use of thrombolytic catheter to contact catheter thrombolysis,placement of the catheter before implantation of inferior vena cava filter to prevent large area PTE.After thrombolytic therapy,the patients with vascular lumen patency were revaluated,and the experimental program was given to the patients.The patients were randomly divided into two groups.3 Random grouping4 Anticoagulant therapyThe experimental group(25 cases)treated with oral anticoagulant therapy of rivaroxaban,the first three weeks of oral rivaroxaban Laval(German Bayer Schering Pharma AG specifications:15mg),two times a day after treatment and maintenance treatment(German Bayer Schering Pharma AG specifications: 20mg),once a day.Blood coagulation function was not detected and followed up for 6 months.The control group(25 cases)with oral anticoagulation with warfarin treatment,the initial treatment for the application of low molecular weight heparin bridging started after taking warfarin,2 times/week monitoring of prothrombin time and international normalized ratio(INR),according to the international normalized ratio index to adjust the dosage of warfarin.When the international normalized ratio reaches 2.0~3.0,the use of low molecular weight heparin.And then continue to maintain oral warfarin therapy,to be more than 3 consecutive INR stable in the 2.0-3.0 interval,can be changed to weekly or a few weeks to monitor.Monitoring of the two groups of patients at the end of the treatment after the treatment for 3 months and 6 months of deep venous ultrasound,new or recurrent DVT events,non fatal PE events,bleeding events,deaths and qualityof life assessment of patients.After the end of the experiment,the SPSS13.0statistical software package was used for statistical analysis to evaluate the safety and efficacy of the drug.Result:1 The experimental group(Rivaroxaban)and control group(Warfarin),in the gender composition,limb type,distribution,age structure and onset time showed no significant difference(P>0.05).2 Clinical efficacy: There was no significant difference between the two groups in the incidence of new or recurrent DVT events in the experimental group(rivaroxaban group)and the control group(warfarin)(P>0.05)The difference between the two groups was statistically significant(P<0.05).Two groups were asymptomatic pulmonary embolism and death events.3 Safety: in the experimental group,one patient had a small amount of epistaxis.The control group of three patients with oral gingival bleeding,two cases of patients with local subcutaneous ecchymosis,one patient with mild hemorrhage after scleral eyes improved after drug withdrawal,and changed to dabigatran anticoagulant therapy,no symptoms,one patient had hematuria.4 Patients with compliance: the experimental group were treated with oral rivaroxaban.In the control group,one patient failed to regularly monitor the international normalized ratio index,and the recurrence of DVT.One patient due to the international standardized ratio fluctuations,and the replacement of other drugs anticoagulant therapy.5 CIVIQ quality of life score: there was no significant difference between the two groups within 3 months(P>0.05),the two groups have no difference in quality of life;there were significant differences between the two groups of3-6 months(P<0.05),experimental group(rivaroxaban)quality of life of patients than the control group(warfarin).Conclusion:1 Through the comparison between the two groups,the experimental group(Rivaroxaban)and the control group(Warfarin)in the short term anticoagulant efficacy was no significant difference.However,in the long-termanticoagulant therapy,the experimental group(Rivaroxaban)anticoagulant effect is better than the control group(Warfarin).And the curative effect is relatively stable.2 Anticoagulant therapy in the experimental group(Rivaroxaban)no bleeding,pulmonary embolism and other related risks,while the control group(Warfarin)bleeding risk events more.It can be concluded that Rivaroxaban 's anticoagulant therapy is safe,but in this study the clinical data are less and the results may have some limitations.3 According to the analysis of the results of the quality life of the patients,there was no significant difference in the quality life between the experimental group(Rivaroxaban)and the control group(Warfarin)in the short term.In the long term anticoagulant therapy,the control group(Warfarin),due to the influence of diet structure,bleeding and patient compliance,anticoa-gulant effect is not stable,easy to relapse DVT,and easy to progress to PTS.It seriously affects the quality life of patients and treatment costs.It is difficult to cure.4 Considering the need for long-term anticoagulant therapy,Rivaroxaban does not need to adjust the dose.It is more convenient,safety,and patient compliance is good,but the price is relatively expensive.