Rivaroxaban Prophylaxis in Non-cirrhotic Portal Vein Thrombosis

Non-cirrhotic portal vein thrombosis is associated with one or several underlying risk factors of thrombosis in 60-70 percent of cases, including major prothrombotic risk factor (e.g. myeloproliferative neoplasms, antiphospholipid syndrome, or homozygous factor V Leiden), and transient (local causes) or mild to moderate risk factors (e.g. heterozygous G20210A factor II or G1691A factor V mutations,…).

Major complications of PVT are portal hypertension gastrointestinal bleeding, and recurrent thrombosis, mainly intestinal infarction. The aim of this randomized open-label controlled trial performed between September 16, 2015 and January 30, 2020, was to assess the efficacy of rivaroxaban 15 mg/day to prevent the recurrence of thromboembolic events or death in patients with a prior history of non-cirrhotic PVT and without major risk factors for thrombosis.

In non-cirrhotic patients with a past history of PVT without major prothrombotic risk factors, long term rivaroxaban p.o. 15 mg once daily reduced the incidence of recurrent venous thrombosis without increased occurrence of major bleeding. D-dimer < 500ng/ml one month after anticoagulation was discontinued predicted a low risk of recurrence by approximately two years.