The effect of rivaroxaban as an anticoagulant therapy for acute pulmonary embolism and the predictive role of vascular endothelial markers in assessing anticoagulant efficacy before treatment.

Abstract

Background: Acute pulmonary embolism (PE) is a life-threatening condition requiring effective anticoagulation therapy. Rivaroxaban, a direct oral anticoagulant, offers advantages over warfarin, yet individual patient responses vary. This study examined the efficacy of rivaroxaban compared to warfarin and evaluated vascular endothelial markers as predictors of anticoagulant efficacy.

Methods: We conducted a retrospective cross-over cohort study involving 295 patients with acute PE, comparing rivaroxaban (n = 158) and warfarin (n = 137) treatments. Clinical efficacy was assessed based on symptomatic improvement and imaging results. Vascular endothelial markers, including soluble thrombomodulin (sTM), circulating endothelial cells (CEC), and endothelin-1 (ET-1), were examined for their predictive capability in treatment outcomes, then the data of 97 additional patients were used for external validation.

Results: Patients who received rivaroxaban showed higher overall treatment response (93.04%) compared to those who took warfarin (74.45%; P < 0.001), and greater improvement in arterial partial pressure of oxygen (PaO₂; P = 0.003). Rivaroxaban significantly altered coagulation parameters such as prothrombin time (PT) and international normalized ratio (INR). In addition, elevated sTM and reduced CEC were found to be associated with poorer anticoagulation outcomes. The areas under the receiver operating characteristic curve (AUCs) for predicting efficacy using vascular endothelial markers were 0.913 in the training cohort and 0.888 in the external validation cohort, respectively.

Conclusion: Rivaroxaban was more effective than warfarin in treating acute PE, with specific vascular endothelial markers serving as promising predictors of therapeutic response.