Comprehensive review of patients with hypercoagulable state in rheumatoid arthritis and strategies to reduce readmission rates: A retrospective cohort study based on protective exploration of traditional Chinese medicine

This study aimed to investigate the effect of traditional Chinese medicine (TCM) intervention on the risk of readmission and laboratory indicators in patients with rheumatoid arthritis hypercoagulable state. In the retrospective cohort design, patients with RA hospitalized between June 2013 and June 2021 at the First Affiliated Hospital of Anhui University of Chinese Medicine were followed up by telephone. Propensity score matching (PSM) was used to balance deviations in baseline information between patients in the hypercoagulable (HC) and non-hypercoagulable (Non-HC) groups, with exposure defined as receiving TCM treatment for ≥ 1 month. Cox proportional hazards model and Kaplan-Meier survival curves were employed to determine the factors influencing the readmission of RA-HC patients. Mantel test and association rule analysis was used to explore the relationship between the included factors and laboratory indicators. A total of 1169 cases were successfully followed up, including 831 RA-HC patients. 1:2 PSM yielded 311 patients in the non-HC group versus 535 patients in the HC group. We observed that the incidence of readmission and surgical treatment was significantly higher in the HC group than in the non-HC group, while the incidence of readmission, surgical treatment, and all-cause mortality was much lower in the exposed group than in the non-exposed group (all P < .05). Based on the Cox proportional risk model, we identified age above 60 years, Sjogren's syndrome, neutrophil count, and neutrophil-lymphocyte ratio (NLR) as risk factors for readmission, with TCM playing a protective role. The Kaplan-Meier survival curves further showed that the risk of readmission in the high-exposure subgroup was markedly lower than that of the low-exposure subgroup. Furthermore, the Mantel test highlights an intrinsic correlation between coagulation markers and other markers such as erythrocyte sedimentation rate (ESR) and hypersensitive c-reactive protein (hs-CRP), which are dramatically influenced by gender, age, etc. In addition, association rule analysis revealed a strong correlation between TCM and non-readmission, as well as improvement in rheumatoid factor, hs-CRP, ESR, platelet count, and NLR in RA-HC patients. As a promising therapeutic strategy, TCM with sufficient intensity and duration interventions can effectively reduce the risk of readmission and relieve laboratory indicators in RA-HC patients.