Association of rivaroxaban blood concentration with adverse reactions in elderly patients undergoing orthopedic surgery

Zhang Leyun; Liu Yuanyuan; Tong Wei; Zhou Jianmei; Chen Nana

doi:10.3969/j.issn.1672-8157.2025.03.043

Abstract：Objective To explore the relationship between rivaroxaban blood concentration and adverse reactions in elderly patients undergoing orthopedic surgery.Methods The clinical data were collected from 97 elderly patients who underwent or-thopedic surgery in the 904th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army from January 2023 to December 2024.All patients received oral rivaroxaban at a dose of 20 mg,and the plasma concentrations of rivaroxaban were measured by liquid chromatography.The incidence rates of adverse reactions were recorded,and the enrolled patients were divided into the adverse reaction group and the non-adverse reaction group.Univariate and multivariate Logistic regression analy-ses were performed to identify influencing factors for adverse reactions,and the value of plasma concentrations in prediction of the risk of adverse reactions was evaluated by means of receiver operating characteristic(ROC)curves.Results In patients receiving 20 mg rivaroxaban,the peak plasma concentration was(182.78±47.51)ng·mL-1,and the trough concentration was(33.13±9.24)ng·mL-1.In this study,gastrointestinal adverse reactions occurred the most,accounting for 52.94%,followed by skin and subcuta-neous tissue adverse reactions,accounting for 17.65%.17 patients with adverse reactions were included in the occurrence group,and the remaining patients were included in the non-occurrence group.The patients with adverse reactions were older than the pa-tients without adverse reactions;the proportion of patients with mild liver and renal abnormalities of the adverse reaction group was higher than that of the non-adverse reaction group;the peak and trough concentrations of rivaroxaban of the adverse reaction group were higher than those of the non-adverse reaction group[(74.89±5.75)years vs(72.00±5.06)years,41.18%vs 16.25%,(199.16±34.19)ng·mL-1 vs(179.30±29.67)ng·mL-1,(42.36±8.10)ng·mL-1 vs(31.17±7.85)ng·mL-1](t=2.088,2.440,5.309,χ2=3.908,P<0.05).Multivariate Logistic regression analysis showed that age,mild liver and renal abnormalities,and peak and trough plasma concentrations of rivaroxaban were all the risk factors for adverse reactions in the patients.ROC curve analysis indicated that the AUCs of peak and trough plasma concentrations of rivaroxaban were respectively 0.664 and 0.841 in prediction of adverse reactions in the elderly patients undergoing orthopedic surgery.The AUC of the joint detection of the two concentrations was 0.923 in pre-diction of adverse reactions,with the sensitivity being 94.11%and thespecificity 90.00%.Conclusion Plasma concentration of rivaroxaban can predict the risk of adverse reactions in elderly patients undergoing orthopedic surgery.The age,mild liver and renal abnormalities,and blood drug concentration can affect the occurrence of adverse reactions.