Clinical Efficacy of Conventional Heparin Anticoagulation Combined with Apixaban in the Treatment of Patients with Cerebral Venous Thrombosis and Its Effect on Serum D-Dimer and FIB Expression

Abstract

Objective: The aim of this study was to explore the clinical efficacy of conventional heparin anticoagulation in combination with apixaban in the treatment of patients with cerebral venous thrombosis (CVT) and its influence on serum D-dimer (D-D) and fibrinogen (FIB).

Methods: One hundred and fifty-seven consecutive CVT patients admitted to our hospital from January 1, 2006, to December 31, 2013, were allocated into two groups according to the different treatment methods, of which 95 cases received standard anticoagulation therapy (standard group (SG)) and the remaining 62 cases were given apixaban therapy (research group (RG)). The curative effects and the changes of coagulation function during the treatment, as well as the incidence of adverse reactions, were analyzed in the two groups. The changes of D-D and FIB levels before treatment and at days 1, 4, and 7 posttreatment were detected.

Results: In treatment efficacy, RG was superior to SG. No evident difference was observed in the incidence of adverse events or coagulation function between the two groups. At day 1 posttreatment, D-D level was increased largely in both SG and RG, but the increase was much more significant in RG. However, D-D level was decreased gradually with time in both groups, and the reduction was more notable in RG. The FIB level in SG declined gradually with time after treatment and was higher than that in RG at the same time point. In RG, FIB was decreased gradually at day 1 and day 4 posttreatment, and its level at day 7 posttreatment showed no difference compared with that at day 4 posttreatment. Spearman's analysis identified that the higher the D-D level or the lower the FIB level at day 1 posttreatment was, the better the treatment efficacy was. After seven-day treatment, the lower the level of D-D and FIB was, the better the therapeutic effect was. Logistic analysis indicated that age, time of diagnosis, deep vein thrombosis (DVT), Glasgow Coma Scale (GCS) score, infection, Apixaban, D-D, and FIB all independently affect the treatment effect of patients.

Conclusions: The combined use of Apixaban with heparin is high-performing and safe in the treatment of CVT. The changes of D-D and FIB levels during the treatment are strongly linked to the therapeutic effect, which can be used as plausible evaluation indexes for the efficacy of CVT.

Figure 1

Comparison of coagulation function between the two groups. (a) Comparison of PLT levels between the two groups before and after treatment. (b) Comparison of APTT levels between the two groups before and after treatment. (c) Comparison of PT levels between the two groups before and after treatment. APTT: activated partial thromboplastin time; PT: partial prothrombin time; PLT: platelet.

Figure 2

Changes of D-dimer and FIB levels in the two groups during treatment. (a) Changes in D-dimer levels. (b) Changes in FIB levels. ^∗P < 0.05vs. standard group at the same time point; ^#P < 0.05vs. before treatment; ^@P < 0.05vs. one day after treatment; ^&P < 0.05vs. four days after treatment. FIB: fibrinogen.

Figure 3

Correlation of D-dimer and FIB levels with therapeutic effect. (a) Relationship between D-dimer and therapeutic effect one day after treatment. (b) Relationship between D-dimer and therapeutic effect 7 days after treatment. (c) Relationship between FIB and therapeutic effect one day after treatment. (d) Relationship between FIB and therapeutic effect 7 days after treatment. FIB: fibrinogen.