AUTHOR=Xiong Wei , Zhao Yunfeng , Liu Song , Du He , Wang Yanmin , Li Wenjie , Guo Xuejun 

TITLE=Sequential Therapy of Nadroparin and Rivaroxaban in the Initial Treatment of Patients With Acute Pulmonary Embolism

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.810455

DOI=10.3389/fphar.2022.810455

ISSN=1663-9812

ABSTRACT=Background: Sequential low molecular weight heparin(LMWH) plus warfarin, LMWH plus edoxaban as well as LMWH plus dabigatran regimens have already showed efficacy and safety in the treatment of acute pulmonary embolism(PE). The efficacy and safety of sequential LMWH plus rivaroxaban regimen in the treatment of acute PE has been understudied. 
Methods: A retrospective study was performed to explore the efficacy and safety of sequential therapy regimens of subcutaneous LMWH( nadroparin 86 IU/kg every 12 hours for a week) followed by oral rivaroxaban(20mg once daily for 3 months) in the management of patients with established acute PE without hemodynamic instability, compared with those of nadroparin plus dabigatran as well as nadroparin plus warfarin.
Results: The number of patients with total resolution of PE were 238(80.1%), 220(78.0%) and 166(62.6%), in the nadroparin+rivaroxaban, nadroparin+dabigatra, and nadroparin+warfarin groups, respectively. (P=0.001) The prevalence of DVT at the 3-month follow-up visit were 18(6.1%), 14(5.0%) and 11(4.2%), in the aforementioned three groups, respectively.(P=0.559) The NT-proBNP level (pg/mL) at the 3-month follow-up visit were 122.5(97.4-158.9) , 131.7(102.2-166.3), and 357.8(275.4-433.2) in three groups, respectively.(P=0.001) The D-dimer level (ng/mL) at the 3-month follow-up visit were 387.3(310.9-465.2) , 432.5(382.4-489.6), and 854.0(721.5-993.7) in three groups, respectively.(P<0.001) The number of patients with major bleeding events were 3(0.9%), 6(1.8%), and 18(5.5%) in three groups, respectively. (P<0.001)
Conclusions: The regimen of sequential subcutaneous nadroparin at body-weight adjusted dose for a week followed by oral rivaroxaban at a dose of 20mg once daily for three months is effective and safe in the initial treatment of patients with acute pulmonary embolism.