Direct oral anticoagulant rivaroxaban for secondary prevention of catheter-related thrombosis in children with intestinal failure: real-life data
Hilberath J, Ballauff A, Rückel A, Sieverding L, Vermeulen D, Eberl W, Hartleif S, Lieber J, Michel J, Sturm E, Nordmeyer J, Icheva V (2025)
Publication Type: Journal article
Publication year: 2025
Journal
Book Volume: 9
Article Number: 103231
Journal Issue: 7
DOI: 10.1016/j.rpth.2025.103231
Abstract
Background: Catheter-related thrombosis (CRT) affects 20% to 57% of pediatric patients with intestinal failure (IF) on long-term parenteral nutrition with risk of venous access loss. Subcutaneous low-molecular-weight heparin is burdensome, with 35% of long-term treated children experiencing recurrent thrombosis. Data on the direct oral anticoagulant (DOAC) rivaroxaban in patients with IF are limited. Objectives: This study aimed to evaluate the characteristics and outcomes of children with IF receiving rivaroxaban for secondary prevention of CRT. Methods: We conducted a multicenter, retrospective longitudinal cohort study in children (0-17 years) with IF treated with rivaroxaban between July 2021 and May 2025. Clinical, diagnostic, imaging, and laboratory data were collected from medical records and analyzed. The study was approved by the institutional ethics board (709/2023BO2). Results: The study included 26 children; 15 children switched to anticoagulation with rivaroxaban to improve adherence due to incompliance with subcutaneous application. Median follow-up until the last imaging assessment was 436 days. In 11 children (42%), rivaroxaban dosage was adjusted due to insufficient drug levels. Two patients demonstrated CRT, corresponding to a rethrombosis rate of 7.7% or 0.2/1000 catheter days. Four patients (15%) experienced intestinal bleeding. Conclusion: This is the first study to provide real-life insights into the use of the DOAC rivaroxaban in children with intestinal failure, demonstrating its potential for secondary CRT prevention and child-friendly administration with very low rethrombosis rate. However, dose adjustments based on therapeutic drug monitoring might be necessary due to heterogeneous variability in absorption. Future prospective and comparative trials are needed to confirm these findings.
Involved external institutions
Universitätsklinikum Tübingen
Germany (DE)
Helios Klinikum Krefeld
Germany (DE)
Städtisches Klinikum Braunschweig
Germany (DE)
Germany (DE)
Helios Klinikum Krefeld
Germany (DE)
Städtisches Klinikum Braunschweig
Germany (DE)
How to cite
APA:
Hilberath, J., Ballauff, A., Rückel, A., Sieverding, L., Vermeulen, D., Eberl, W.,... Icheva, V. (2025). Direct oral anticoagulant rivaroxaban for secondary prevention of catheter-related thrombosis in children with intestinal failure: real-life data. Research and Practice in Thrombosis and Haemostasis, 9(7). https://doi.org/10.1016/j.rpth.2025.103231
MLA:
Hilberath, Johannes, et al. "Direct oral anticoagulant rivaroxaban for secondary prevention of catheter-related thrombosis in children with intestinal failure: real-life data." Research and Practice in Thrombosis and Haemostasis 9.7 (2025).
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