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.

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

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

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.