Objective To investigate the effect of methylprednisolone combined with rivaroxaban on myocardial ischemia and hypoxia injury for acute exacerbated COPD combined with pulmonary embolism. Methods The clinical data of 96 patients with acute exacerbated COPD combined with pulmonary embolism admitted to our hospital from February 2014 to February 2018 were retrospectively analyzed. The patients were divided into observation group and control group (48 cases each), according to the different treatment methods. The control group was given rivaroxaban combined with routine treatment, and based on this. The observation group was treated with methylprednisolone. Then the curative effect, occurrence of adverse reactions, coagulation function, D-dimer, lung function, blood gas analysis, cTnI, and inflammatory index levels before and after treatment were compared between the two groups. Results he total effective rate in the observation group was higher than that in the control group (89.58% vs 72.92%, X2=4.376,P=0.036). After treatment, the levels of FVC, FEV1, FEV1/FVC, and 6minute walking distance were increased in both groups (P＜0.05), and were higher in the observation group than in the control group (P＜0.05). After treatment, the APTT, PT, FIB, TT, and Ddimer levels in the two groups were decreased, and FIB level was increased (P＜0.05). The APTT, PT, FIB, TT, and FIB levels of the two groups had no significant difference (P＞0.05). While the Ddimer level in the observation group was lower than that in the control group (P＜0.05). After treatment, serum levels of PCT, CRP and IL6 in the two groups were decreased (P＜0.05), and were lower in the observation group than in the control group (P＜0.05). After treatment, serum PaCO2 and cTnI levels in the two groups were decreased, and PaO2 was increased (P＜0.05), and the observation group had lower levels of PaCO2 and cTnI and higher level of PaO2 than those in the control group (P＜0.05). The overall incidence rate of adverse reactions of two groups was not statistically different ［14.58% VS 10.42%, X2= 0.381, P=0.537］. Conclusion 〓The methylprednisolone combined with rivaroxaban can effectively ameliorate the lung function, blood hypercoagulability, blood gas analysis and myocardial ischemia and hypoxia injury with no serious adverse reactions for patients with acute exacerbated COPD combined with pulmonary embolism. 