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EFFICACY AND SAFETY EVALUATION OF LOW MOLECULAR WEIGHT HEPARIN COMBINED WITH RIVAROXABAN IN THE TREATMENT OF ELDERLY PATIENTS WITH ACUTE PULMONARY EMBOLISM

JIAN ZHANG ¹, YEFEI RUAN ¹, XUEQING SHEN ²*

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This retrospective study compared the efficacy and safety of low molecular weight heparin (LMWH) combined with rivarox- aban versus LMWH plus warfarin in elderly patients with acute pulmonary embolism (PE). A total of 159 patients aged > 60 years with intermediate-low risk acute PE were included: 79 received LMWH plus warfarin and 80 received LMWH plus rivaroxaban. Clinical efficacy, coagulation parameters, biochemical markers, cardiopulmonary function, CTPA findings, and adverse events were evaluated up to 6 months after treatment. The total effective rate was significantly higher in the rivarox- aban group than in the warfarin group (86.25% vs. 69.62%, p = 0.042). Patients treated with rivaroxaban showed better coag- ulation profiles, including longer PT and lower D-dimer levels, improved oxygenation (PaO₂), and a higher thrombus lysis rate (all p < 0.05). In addition, bleeding events and the need for INR monitoring were significantly reduced in the rivaroxaban group. No significant differences were observed in gastrointestinal reactions or re-embolism rates. LMWH combined with rivaroxaban demonstrated superior efficacy and safety compared with the conventional warfarin regimen and may represent a preferable anticoagulation strategy in elderly patients with acute PE.