Abstract:
Background: Central venous catheters are prone to clotting, particularly in patients with cancer. Although low-molecular-weight heparin and direct oral anticoagulants, such as apixaban and rivaroxaban, have been evaluated for the prevention of catheter thrombosis, their efficacy remains uncertain.
Objectives: Compare apixaban and rivaroxaban with enoxaparin for the prevention of catheter-induced clotting in vitro.
Methods: To address this uncertainty, we used a well-established microplate-based assay to compare the effects of enoxaparin, apixaban, and rivaroxaban on catheter-induced thrombosis and thrombin generation in human plasma.
Results: Consistent with our previous findings, catheter segments shortened the clotting time and promoted thrombin generation. When compared at concentrations with similar anti-factor Xa activity as enoxaparin, apixaban and rivaroxaban were >20-fold less potent than enoxaparin for the prevention of catheter-induced clotting and thrombin generation.
Conclusion: The prevention of catheter thrombosis in patients with cancer is challenging. Clinical trials are needed to compare the efficacy of low-molecular-weight heparin with that of direct oral anticoagulants both for the prevention and treatment of catheter thrombosis.
Reference:Guan Z, Wang R, Hussain RH, Fredenburgh JC, Jaffer IH, Weitz JI. Rivaroxaban and apixaban are less effective than enoxaparin for the prevention of catheter-induced clotting in vitro. J Thromb Haemost. 2023 Jan;21(1):76-82. doi: 10.1016/j.jtha.2022.10.020. Epub 2022 Dec 22. PMID: 36695399.