Direct oral anticoagulant rivaroxaban for secondary prevention of catheter-related thrombosis in children with intestinal failure: real-life data

Background: Catheter-related thrombosis (CRT) affects 20-57% of paediatric patients with intestinal failure (pIF) on parenteral nutrition.Subcutaneous low-molecular-weight heparin is burdensome, with 35% of treated children experiencing re-thrombosis.This study aimed to determine the feasibility, safety, and outcomes of oral rivaroxaban in pIF patients.Methods: Multicentre, retrospective analysis of all children with IF who were treated with rivaroxaban for secondary prevention of CRT between 07/2021-01/2025.Results: Overall, 26 patients were enrolled in this study (Table 1).In ten children (38.5%), rivaroxaban dosage was increased to reach targeted drug levels.One patient in the cohort developed asymptomatic CRT, corresponding to a rethrombosis rate of 3.9% or 0.1/1000 catheter-days.During follow-up, four patients (15.4%) discontinued medication and one patient (3.9%) died from pre-existing chronic liver failure unrelated to rivaroxaban.Twelve children (46.2%) underwent surgery without perioperative complications.In two patients, rivaroxaban was temporarily discontinued because of intestinal bleeding.Conclusions: This is the first case series of rivaroxaban use in children with IF.The low secondary CRT rate makes it a promising anticoagulation option in this unique group of patients.Administration was feasible; however, dosage adjustments for adequate drug levels and monitoring for intestinal bleeding are necessary.Controlled trials are required to confirm our results.