Rivaroxaban for the treatment of noncirrhotic splanchnic vein thrombosis: an interventional prospective cohort study

Walter Ageno, Jan Beyer Westendorf, Laura Contino, Eugenio Bucherini, Maria Teresa Sartori, Marco Senzolo, Elvira Grandone, Rita Santoro, Marc Carrier, Aurélien Delluc, Valerio De Stefano, Fulvio Pomero, Marco Paolo Donadini, Alberto Tosetto, Cecilia Becattini, Ida Martinelli, Barbara Nardo, Laurent Bertoletti, Marcello Di Nisio, Alejandro Lazo-Langner, Alessandro Schenone, Nicoletta Riva, Walter Ageno, Jan Beyer Westendorf, Laura Contino, Eugenio Bucherini, Maria Teresa Sartori, Marco Senzolo, Elvira Grandone, Rita Santoro, Marc Carrier, Aurélien Delluc, Valerio De Stefano, Fulvio Pomero, Marco Paolo Donadini, Alberto Tosetto, Cecilia Becattini, Ida Martinelli, Barbara Nardo, Laurent Bertoletti, Marcello Di Nisio, Alejandro Lazo-Langner, Alessandro Schenone, Nicoletta Riva

Abstract

Heparins and vitamin K antagonists are the mainstay of treatment of splanchnic vein thrombosis (SVT). Rivaroxaban is a potential alternative, but data to support its use are limited. We aimed to evaluate the safety and efficacy of rivaroxaban for the treatment of acute SVT. In an international, single-arm clinical trial, adult patients with a first episode of noncirrhotic, symptomatic, objectively diagnosed SVT received rivaroxaban 15 mg twice daily for 3 weeks, followed by 20 mg daily for an intended duration of 3 months. Patients with Budd-Chiari syndrome and those receiving full-dose anticoagulation for >7 days prior to enrollment were excluded. Primary outcome was major bleeding; secondary outcomes included death, recurrent SVT, and complete vein recanalization within 3 months. Patients were followed for a total of 6 months. A total of 103 patients were enrolled; 100 were eligible for the analysis. Mean age was 54.4 years; 64% were men. SVT risk factors included abdominal inflammation/infection (28%), solid cancer (9%), myeloproliferative neoplasms (9%), and hormonal therapy (9%); 43% of cases were unprovoked. JAK2 V617F mutation was detected in 26% of 50 tested patients. At 3 months, 2 patients (2.1%; 95% confidence interval, 0.6-7.2) had major bleeding events (both gastrointestinal). One (1.0%) patient died due to a non-SVT-related cause, 2 had recurrent SVT (2.1%). Complete recanalization was documented in 47.3% of patients. One additional major bleeding event and 1 recurrent SVT occurred at 6 months. Rivaroxaban appears as a potential alternative to standard anticoagulation for the treatment of SVT in non-cirrhotic patients. This trial was registered at www.clinicaltrials.gov as #NCT02627053 and at eudract.ema.europa.eu as #2014-005162-29-36.

© 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Flowchart of the enrolled population.
Figure 2.
Figure 2.
Cumulative incidence of major bleeding, clinically relevant non-major bleeding, and SVT recurrent events.

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