Clinical study on the diagnostic value of left atrial anterior posterior diameter combined with red blood cell volume distribution width for the stability of warfarin anticoagulation in elderly patients

YU Bin; LUO Xiao; YUAN Mingqing; LIU Wanqian; CHEN Ling

Abstract：Objective:To explore the diagnostic and predictive value of left atrial anterior posterior diameter com-bined with red blood cell volume distribution width for the stability of warfarin anticoagulation.Methods:All 143 pa-tients who received anticoagulation treatment with warfarin and had complete follow-up data from June 2021 to June 2023 were selected as the study subjects.Firstly,all study subjects were divided into a high-quality anticoagulant sta-bility group and a non high-quality anticoagulant stability group based on whether the anticoagulation stability(TTR)was≥70%.The differences and similarities between the two groups in terms of gender,age,comorbidities,hematologi-cal examination,and color ultrasound examination were compared,and conduct correlation analysis and binary logistic regression analysis on relevant indicators to explore possible factors that may affect TTR.Then,select the most correla-ted influencing factor in color ultrasound and compare and analyze it with the influencing factors in hematological exam-ination.Conduct separate and combined predictive value evaluations.Results:The comparison of activated partial throm-bin time(APTT),white blood cells(WBC),red blood cells(RBC),platelet distribution width(PDW),mean platelet volume(MPV),red blood cell volume distribution width(RDW),lipoprotein a[Lp(a)],left atrial anteroposterior di-ameter(LA-APD),right atrial ascending and descending diameter(RA-VD),left ventricular end systolic diameter(LVDs)and stroke output(SV)between the high-quality and non high-quality groups of warfarin anticoagulant sta-bility showed statistically significant differences(P＜0.05).Prothrombin time(PT),APTT,hemoglobin(Hb),RDW,LA-APD,left atrial up-and-down diameter(LA-VD),RA-VD and LVDs are the influencing factors of the anti-coagulation quality of warfarin.The AUC for Hb diagnosis of high-quality anticoagulation with warfarin is 0.676(95%CI:0.587～0.766),with sensitivity and specificity of 0.788 and 0.560,respectively.The Jordan index is 0.348,and the corresponding optimal cutoff value is 124%.The AUC for diagnosing high-quality anticoagulation with warfa-rin by RDW is 0.640(95%CI:0.545～0.735),with sensitivity and specificity of 0.538 and 0.725,respectively.The Jordan index is 0.263,and the corresponding optimal cutoff value is 13.95%.The AUC for LA-APD diagnosis of high-quality anticoagulation with warfarin is 0.867(95%CI:0.803～0.932),with sensitivity and specificity of 0.904 and 0.813,respectively.The Jordan index is 0.717,and the corresponding optimal cutoff value is 36.5%.The AUC of LA-APD combined with Hb for diagnosing high-quality anticoagulation with warfarin is 0.882(95%CI:0.821～0.942),with sensi-tivity and specificity of 0.885 and 0.857,respectively.The Jordan index is 0.742,and the corresponding optimal cutoff value is 0.464.The combination of LA-APD and RDW for diagnosing high-quality AUC of warfarin anticoagulation is 0.889(95%CI:0.831～0.947),with sensitivity and specificity of 0.923 and 0.813,respectively.The Jordan index is 0.736,and the corresponding optimal cutoff value is 0.346%.Conclusion:The predictive diagnostic value of left atrial anterior posterior diameter combined with red blood cell volume distribution width for the stability of warfarin anticoag-ulation is good.