Clinical Analysis Of Gastrointestinal Bleeding In Patients With Oral Rivaroxaban

Objective:This study retrospectively analyzed the clinical data of patients with oral rivaroxaban,explored the risk factors and clinical characteristics of gastrointestinal bleeding in such patients,and provided a basis for clinical medication and prevention of complications.Methods:This study collected clinical data of 836 patients who were treated for thromboembolic diseases in The Second Hospital of Jilin University from January 2019 to September 2020 and who took rivaroxaban for 3 months or more,including the patient’s age,Gender,BMI,history of drinking,history of chronic diseases(hypertension,diabetes,coronary heart disease,etc.),gastrointestinal symptoms and medical history(such as abdominal pain,abdominal distension,peptic ulcer,subtotal gastrectomy,etc.),dosage,Combined medication history(aspirin,clopidogrel,proton pump inhibitor),initial test indicators for all patients(blood routine,liver function,blood coagulation indicators,etc.),relevant indicators for re-diagnosis of bleeding patients(blood routine,coagulation indicators,endoscopic performance)And treatment conditions.Through inpatient data,outpatient follow-up and telephone follow-up,we can understand the occurrence of gastrointestinal bleeding within 3months.Finally,the case data of all patients were analyzed and summarized,and SPSS 26.0statistical software was used for statistical analysis of the collected data.P<0.05 indicates that the difference is statistically significant.Result:(1)General characteristics: 1021 patients were initially enrolled in this study.A total of185 patients were excluded from random replacement of anticoagulant dosage and anticoagulant drugs,bleeding from other parts,and incomplete medical history data.Finally,836 patients were enrolled.Among them,there were 461 males(55.1%)and 375 females(44.9%),the ratio was about 1:1.The average age is 65.9 years old,the oldest age is 91 years old,and the youngest age is 23 years old.(2)Occurrence of gastrointestinal bleeding: 31 cases(3.7%)of patients had gastrointestinal bleeding during the medication period,of which 16 cases(1.9%)had gastrointestinal bleeding.The clinical manifestations were mainly melena and occult blood in stool.Seventeen patients underwent gastroscopy,and the results were more common with peptic ulcers.(3)Risk factors related to gastrointestinal bleeding: univariate analysis of baseline clinical data of gastrointestinal bleeding group and non-bleeding group showed that the two groups had gastrointestinal related symptoms and medical history,combined antiplatelet drugs,baseline albumin value and cholinesterase value.Statistically significant,Logistic regression analysis showed gastrointestinal related symptoms and medical history,combined use of antiplatelet drugs and baseline albumin level <30g/l were independent risk factors for gastrointestinal bleeding in patients with oral rivaroxaban.Univariate analysis of baseline clinical data of gastrointestinal bleeding group and non-major bleeding group showed that the baseline albumin value and baseline albumin level of the two groups The difference of<30g/l was statistically significant,and the P value was <0.05.(4)Comparison of coagulation indicators: Prothrombin time(PT)in the gastrointestinal bleeding group was 15.1(13.3,18.3)s,and in the non-bleeding group 14.1(12.6),16.0)s,the difference was statistically significant(P<0.05);the international normalization ratio(INR)of the bleeding group was 1.32(1.150,1.530),and the non-bleeding group was 1.21(1.08,1.37),the difference was statistical Scientific significance(P<0.05);Activated Partial thrombo Plastin time(APTT)in the bleeding group was 34.6(26.5,39.7)s,and the non-bleeding group was 33.7(31.2,37.1)s,the difference was not statistically significant(P=0.667>0.05).There was no significant difference in PT,APTT and INR between the gastrointestinal hemorrhage group and the non-major hemorrhage group(P>0.05).(5)Treatment of gastrointestinal bleeding: 31 patients were given symptomatic treatment,with an average treatment time of(5.1±1.4)days,and no deaths.Conclusion:(1)Gastrointestinal bleeding in patients with oral rivaroxaban is mainly melena and positive fecal occult blood,and fecal occult blood can be monitored during the medication process;patients with high risk factors for gastrointestinal bleeding can complete the gastrointestinal endoscopy before medication.(2)Patients with oral rivaroxaban who have gastrointestinal-related symptoms and medical history,combined antiplatelet drugs or baseline albumin level <30g/l,are at higher risk of gastrointestinal bleeding;and baseline albumin level <30g /l patients are at risk of massive gastrointestinal bleeding.(3)Patients with oral rivaroxaban can monitor the PT and INR values during the medication.If abnormally elevated,beware of bleeding events.