Rivaroxaban prophylaxis and catheter-related thrombosis risk in ambulatory gynecological cancer patients: a retrospective cohort study.

OBJECTIVE

Catheter-related thrombosis (CRT) poses significant risks for gynecologic cancer patients with central venous access devices. This retrospective cohort study evaluated the association between prophylactic rivaroxaban and catheter-related thrombosis in gynecologic oncology outpatients.

METHODS

This single-center study at Fujian Maternity and Child Health Hospital (January 2021-June 2025) included 351 gynecologic oncology patients with peripherally inserted central catheters or implantable venous access ports. Primary exposure was rivaroxaban 10 mg daily for ≥ 30 days. Primary outcome was imaging-confirmed catheter-related thrombosis within 180 days. Inverse probability of treatment weighting (IPTW) was used to address confounding.

RESULTS

Among 351 patients (120 rivaroxaban, 231 controls), CRT occurred in 3 (2.5%) versus 42 (18.2%) patients, respectively (hazard ratio [HR] 0.12, 95% confidence interval [CI] 0.04-0.41; p < 0.001). The IPTW analysis confirmed this association (weighted HR 0.14, 95% CI 0.05-0.44). Major bleeding rates were 1.7% vs. 0.4% (HR 3.86, 95% CI 0.35-42.75; p = 0.273). Clinically relevant non-major bleeding occurred in 6.7% vs. 3.0% (HR 2.23, 95% CI 0.81-6.16; p = 0.121).

CONCLUSION

In this retrospective cohort study, prophylactic rivaroxaban was associated with lower catheter-related thrombosis incidence in gynecologic cancer patients. These observational findings warrant prospective randomized validation.

CLINICAL TRIAL NUMBER: Not applicable.