Effect of rivaroxaban in patients with acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 JIANG Gang , ZHANG Weidong , PENG Minlian

Department of Respiratory Medicine, Hunan Provincial People’s Hospital, Changsha, Hunan 410005, P. R. China;

Corresponding?author：

JIANG Gang, Email: jianggang68@163.com

Keywords：

Rivaroxaban; Pulmonary thromboembolism; Deep vein thrombosis of lower limbs; Warfarin

DOI：

10.7507/1671-6205.201704018

Video：

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Objective To explore clinical effect and safety of rivaroxaban in treatment of acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs. Methods The clinical data of 60 patients with acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, collected from January 2010 to March 2017 in Hunan Provincial People’s Hospital, were retrospectively analyzed. According to the different treatment, these patients were randomly divided into a rivaroxaban group and a control group (traditional warfarin anticoagulation), with 30 patients in each group. The clinical effect and safety were compared between two groups on the 10^th day, 20^th day and 30^th day after treatment. Results Compared with the control group, maximum short axis diameter, ratio of right and left ventricles, systolic pulmonary artery pressure, and main pulmonary artery diameter measured by CTPA and echocardiography in the rivaroxaban group were not significantly different on the 10^th day, 20^th day and 30^th day after treatment. However, the intragroup differences were statistically significant at different timepoint (P<0.05). Levels of N-terminal-pro-brain natriuretic peptide of two groups after treatment were significantly reduced on the 10^th day, 20^th day and 30^th day after treatment, and the values of PO₂ were significantly increased on the 10^th day and 20^th day after treatment (P<0.05), but no significant differences were found in the values of PO₂ on 20^th day and 30^th day after treatment. D-dimer in the two groups was obviously increased on the 10^th day after treatment but significantly declined on the 20^th day and 30^th day after treatment (all P<0.05). These changes were predominant in the rivaroxaban group. Conclusion Rivaroxaban is effective and safe for acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, and worthy of clinical implementation and application.

Citation： JIANG Gang, ZHANG Weidong, PENG Minlian. Effect of rivaroxaban in patients with acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(2): 172-177. doi: 10.7507/1671-6205.201704018 Copy

1.	Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest, 2016, 149(2): 315-352.
2.	Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidlines on the diagnosis and management of actue pulmonary embolism.Kardio Pol, 2014, 72(11): 997-1053.
3.	中華醫學會外科學分會血管外科學組. 深靜脈血栓形成的診斷和治療指南. 2012, 50(7): 611-614.
4.	Büller HR, Prins MH, Lensin AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366 (14): 1287-1297.
5.	Beyer WJ, Lensing AW, Arya R, et al. Choosing wisely: the impact of patient selection on efficacy and safety outcomes in the EINSTEIN-DVT/PE and AMPLIFY trials.Thromb Res, 2017, 149: 29-37.
6.	Weekes AJ, Thacker G, Troha D, et al. Diagnostic accuracy of right ventricular dysfunction markers in normotensive emergency department patients with acute pulmonary embolism. Ann Emerg Med, 2016, 68(3): 277-291.
7.	Park JR, Chang SA, Jang SY, et al. Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography.Int J Cardiovasc Imaging, 2012, 28(4): 979-987.
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10.	Meinel FG, Nance JW, Schoepf UJ, et al. Predictive value of computed tomography in acute pulmonary embolism: systematic review and Meta-analysis.Am J Med, 2015, 128(7): 747-759.
11.	Trujillo-Santos J, den Exter PL, Gómez V, et al. Computed tomography-assessed right ventricular dysfunction and risk stratification of patients with acute non-massive pulmonary embolism: systematic review and meta-analysis.J Thromb Haemost, 2013, 11(10): 1823-1832.
12.	Keller K, Beule J, Schulz A, et al. Right ventricular dysfunction in hemodynamically stable patients with actue pulmonary embolism.Thromb Res, 2014, 133(4): 555-559.
13.	Kreit JW.The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism.Chest, 2004, 125: 1539-1545.
14.	Cho JH, Kutti Sridharan G, Kim SH. Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis. BMC Cardiovasc Disord, 2014, doi: 10.1186/1471-2261-14-64.
15.	Bing R, Chow V, Lau JK, et al. Prevalence of echocardiography use in patients hospitalized with confirmed acute pulmonary embolism: a real-world observational multicenter study.Plos One, 2016, 11(12): e0168554.
16.	Celik Y, Yardan T, Baydin A, et al. The role of NT-proBNP and Apelin in the assessment of right ventricular dysfunction in acute pulmonary embolism.J Pak Med Assoc, 2016, 66(3): 306-311.
17.	Lankeit M, Jiménez D, Kostrubiec M, et al. Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism.Eur Respir J, 2014, 43(6): 1669-1677.
18.	Bircan A, Karadeniz N, Ozden A, et al. A simple clinical model composed of ECG, shock index, and arterial blood gas analysis for predicting severe pulmonary embolism.Clin Appl Thromb Hemost, 2011;17(2): 188-196.
19.	Ince O, Altintas N, Findik S, et al. Risk stratification in submassive pulmonary embolism via alveolar-arterial oxygen gradient.Hippokratia, 2014, 18(4): 333-339.
20.	Ozsu S, Abul Y, Yilmaz I, et al. Prognostic significance of PaO2/PaCO2 ratio in normotensive patients with pulmonary embolism.Clin Respir J, 2012, 6(2): 104-111.

1. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest, 2016, 149(2): 315-352.
2. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidlines on the diagnosis and management of actue pulmonary embolism.Kardio Pol, 2014, 72(11): 997-1053.
3. 中華醫學會外科學分會血管外科學組. 深靜脈血栓形成的診斷和治療指南. 2012, 50(7): 611-614.
4. Büller HR, Prins MH, Lensin AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366 (14): 1287-1297.
5. Beyer WJ, Lensing AW, Arya R, et al. Choosing wisely: the impact of patient selection on efficacy and safety outcomes in the EINSTEIN-DVT/PE and AMPLIFY trials.Thromb Res, 2017, 149: 29-37.
6. Weekes AJ, Thacker G, Troha D, et al. Diagnostic accuracy of right ventricular dysfunction markers in normotensive emergency department patients with acute pulmonary embolism. Ann Emerg Med, 2016, 68(3): 277-291.
7. Park JR, Chang SA, Jang SY, et al. Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography.Int J Cardiovasc Imaging, 2012, 28(4): 979-987.
8. Zhao DJ, Ma DQ, He W, et al. Cardiovascular parameters to assess the severity of acute pulmonary embolism with computed tomography.Acta Radio, 2010, 51(4): 413-419.
9. Jimenez D, Lobo JL, Monreal M, et al. Prognostic significance of multidetector CT in normotensive patients with pulmonary embolism: results of the protect study.Thorax, 2014, 69(2): 109-115.
10. Meinel FG, Nance JW, Schoepf UJ, et al. Predictive value of computed tomography in acute pulmonary embolism: systematic review and Meta-analysis.Am J Med, 2015, 128(7): 747-759.
11. Trujillo-Santos J, den Exter PL, Gómez V, et al. Computed tomography-assessed right ventricular dysfunction and risk stratification of patients with acute non-massive pulmonary embolism: systematic review and meta-analysis.J Thromb Haemost, 2013, 11(10): 1823-1832.
12. Keller K, Beule J, Schulz A, et al. Right ventricular dysfunction in hemodynamically stable patients with actue pulmonary embolism.Thromb Res, 2014, 133(4): 555-559.
13. Kreit JW.The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism.Chest, 2004, 125: 1539-1545.
14. Cho JH, Kutti Sridharan G, Kim SH. Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis. BMC Cardiovasc Disord, 2014, doi: 10.1186/1471-2261-14-64.
15. Bing R, Chow V, Lau JK, et al. Prevalence of echocardiography use in patients hospitalized with confirmed acute pulmonary embolism: a real-world observational multicenter study.Plos One, 2016, 11(12): e0168554.
16. Celik Y, Yardan T, Baydin A, et al. The role of NT-proBNP and Apelin in the assessment of right ventricular dysfunction in acute pulmonary embolism.J Pak Med Assoc, 2016, 66(3): 306-311.
17. Lankeit M, Jiménez D, Kostrubiec M, et al. Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism.Eur Respir J, 2014, 43(6): 1669-1677.
18. Bircan A, Karadeniz N, Ozden A, et al. A simple clinical model composed of ECG, shock index, and arterial blood gas analysis for predicting severe pulmonary embolism.Clin Appl Thromb Hemost, 2011;17(2): 188-196.
19. Ince O, Altintas N, Findik S, et al. Risk stratification in submassive pulmonary embolism via alveolar-arterial oxygen gradient.Hippokratia, 2014, 18(4): 333-339.
20. Ozsu S, Abul Y, Yilmaz I, et al. Prognostic significance of PaO2/PaCO2 ratio in normotensive patients with pulmonary embolism.Clin Respir J, 2012, 6(2): 104-111.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of rivaroxaban in patients with acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs

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