Thromboelastography Evaluating The Efficacy Observation In Livedoid Vasculopathy Received Rivaroxaban

Objective:(1)To analyze the clinical information of 20 cases of Livedoid Vasculopathy,so as to improve the overall awareness of the disease;(2)The purpose is to explore the relationship between coagulation and fibrinolysis and LV,provide a monitoring method for rivaroxaban anticoagulant therapy in livedoid vasculopathy and to assess the clinical efficacy of rivaroxaban.Methods:(1)Clinical data,including the population and age,the clinical and pathological presentation,laboratory examination and treatment in patients with livedoid vasculopathy from July 2018 to December 2020 were retrospective analyzed;(2)The research object was20 patients with LV,were treat with oral rivaroxaban 10 mg daily and received TEG determination before oral rivaroxaban and weeks4,8 after therapy,the control group was 20 healthy subjects,also perfected TEG detection and compared them;(3)Assessing skin involvement before oral rivaroxaban and weeks 2,4,6 and 8 after therapy based on clinical score;(4)According to the visual analogue score(VAS),evaluated the degree of pain before oral rivaroxaban and weeks 2,4,6 and 8 after therapy;(5)Safety assessment based on descriptive method,records all adverse reactions and treatments during the treatment period;(6)Statistical analysis was performed using SPSS 22.0 software,measurement data were expressed as mean ± standard deviation((?)±s)independent sample t test and repeated measures analysis of variance were used for comparison,and Bonferroni method was used for pairwise comparison between after treatment and before treatment;α=0.05.Results:1.The 20 cases of LV including 14 female and 6 male,the ratio was1:2.3.The average age of the patients was 34.25±10.83 years,the shortest course of disease was 2 months and the longest was 10 years.In this group of patients,14 cases were worsened in summer,and 6 cases had no obvious seasonality.lesions commonly occurred in bilateral shanks and ankles,All patients had painful erythema and purpura.Among them,12 cases showed grape branch-like plaque,15 cases developed ulcers of different degrees from erythema and purpura,7 cases showed porcelain white stellate atrophy,and 20 cases had pigmentation in the late stage.The pigmentation is heavy on the ankles.Pathological biopsy prompt thrombosis was seen in the dermal lumen,17 cases were in the superficial dermis,3 cases were deep into the subcutaneous fat layer,20 cases showed swelling and fibrinoid degeneration of vascular endothelial cells,19 cases of peripheral lymphocyte infiltration,no neutrophils and nuclear dust.Laboratory examination of 11 cases of TEG suggest abnormal,6cases of lipoprotein a increased,case of high anti-hemolytic streptococcal antibodies,2 cases of protein C decreased,2 cases of elevated erythrocyte sedimentation rate,and 1 case of weakly positive antinuclear antibodies.the patients were effectively treated with oral rivaroxaban,severe ulcers were treated with dressing change and He-Ne laser treatment,one case relapsed after 10 months of follow-up,and recovered after taking rivaroxaban again.2.TEG shows that compaired with the control group,R value and K value were decreased,with statistically significant difference(P<0.05).the MA,Angle,and CI were not statistically significant(P>0.05).3.R value and K value on the 4 and 8weeks after therapy was incressed than that before oral rivaroxaban,with statistically significant difference(P < 0.05).But there was no significant change between 4weeks and 8 weeks,the difference was not statistically significant(P>0.05);the MA value,Angle value,and CI value were not statistically significant(P>0.05).4.The total clinical scores of 20 patients before oral rivaroxaban and 2,4,6,and 8 weeks after oral the drug were(6.10±1.77),(4.95±1.73),(3.20±1.67),(2.00±1.26),(0.90±0.97)points,decrease sequentially(F=89.643,P<0.001).5.VAS scores of 20 patients before oral rivaroxaban and 2,4,6,and8 weeks after therapy were(4.85±1.18),(3.35±1.18),(2.10±0.85),(0.9±0.64),(0.2±0.41)points,decrease sequentially(F=109.51,P<0.001).Conclusion:1.The disease predisposed to young females,lesions commonly occurred in bilateral shanks and ankles,mostly manifested as erythema,purpura,ecchymosis,painful ulcer,leaving atrophie blanche and pigmentation after the lesions subsided.The clinical manifestations are basically consistent with previous reports.The pathology has no typical changes in vasculitis,but is characterized by dermal venule thrombosis.Thrombosis can also involve the subcutaneous tissue,combined with pathology and experiment Laboratory examination,treatment is based on anticoagulation.2.The coagulation activity of patients with LV is in an enhanced state,TEG can predict the anticoagulant efficacy of oral rivaroxaban in patients with LV through the changes of R and K values,and provide clinicians with monitoring methods for individualized anticoagulation therapy.3.Rivaroxaban has a significant clinical effect in the treatment of LV.It can effectively reduce pain in a short period of time and promote the healing of erythema and ulcers.It has high safety and no obvious adverse reactions.It can provide reference for clinicians in the treatment of LV.