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已发表论文
利伐沙班用于长期静脉通路装置置入的癌症患者血栓预防的评估：一项回顾性队列研究
Authors Jia B , Lv H, Gong T, Wang X, Ma Q, Ren Y, Zhang L, Zhong D
Received 17 July 2025
Accepted for publication 26 October 2025
Published 5 November 2025 Volume 2025:21 Pages 917—925
DOI https://doi.org/10.2147/VHRM.S550388
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Harry Struijker-Boudier
Bin Jia,1,* Hui Lv,2,* Ting Gong,2 Xin Wang,2 Qing Ma,2 Yaoyao Ren,2 Linlin Zhang,2 Diansheng Zhong2
1Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, People’s Republic of China; 2Department of Medical Oncology, Tianjin Medical University General Hospital, Heping, Tianjin, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Diansheng Zhong, Tianjin Medical University General Hospital, Department of Medical Oncology, Tianjin, People’s Republic of China, Email dzhong@tmu.edu.cn Linlin Zhang, Tianjin Medical University General Hospital, Department of Medical Oncology, Tianjin, People’s Republic of China, Email zllcaroline@tmu.edu.cn
Background: Long-term venous access devices, including PICCs and implantable ports, increase the risk of catheter-related thrombosis (CRT) in cancer patients. The role of prophylactic rivaroxaban in this setting remains uncertain.
Methods: We retrospectively analyzed adult cancer patients who underwent peripherally inserted central catheter (PICC) or implantable port (PORT) placement between January 2019 and May 2023. CRT was diagnosed via B-ultrasound. To reduce surveillance bias, only patients who underwent ≥ 4 ultrasound examinations were included. Kaplan–Meier and Cox regression were used to assess the effect of rivaroxaban prophylaxis and to explore subgroup differences.
Results: Among 1,585 patients with upper-limb catheters, 822 met inclusion criteria, with 135 CRT events. The median time to CRT was 55 days (IQR: 29.5– 121.5), and 66.2% occurred within 90 days post-catheterization. Prophylactic rivaroxaban significantly reduced CRT risk (HR = 0.47, 95% CI: 0.33– 0.67; p < 0.001), particularly in high-risk groups such as those with PICC lines or active tumors. No significant benefit was observed in patients with no-evidence-of-disease (NED) or those with cardiac stents, atrial fibrillation, or prior cerebral infarction. In the PORT subgroup, risk reduction was not statistically significant overall (HR = 0.66, p = 0.07), but became significant after excluding NED and cardiovascular conditions (HR = 0.52, p = 0.0195).
Conclusion: Rivaroxaban prophylaxis reduces CRT in cancer patients with long term central venous catheters, particularly those with PICCs or active disease. Routine use appears unnecessary in NED or patients on antiplatelet therapy, highlighting the importance of individualized prophylaxis strategies.
Keywords: anticoagulant, neoplasm, prophylaxis, thrombosis, central venous catheter
1Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, People’s Republic of China; 2Department of Medical Oncology, Tianjin Medical University General Hospital, Heping, Tianjin, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Diansheng Zhong, Tianjin Medical University General Hospital, Department of Medical Oncology, Tianjin, People’s Republic of China, Email dzhong@tmu.edu.cn Linlin Zhang, Tianjin Medical University General Hospital, Department of Medical Oncology, Tianjin, People’s Republic of China, Email zllcaroline@tmu.edu.cn
Background: Long-term venous access devices, including PICCs and implantable ports, increase the risk of catheter-related thrombosis (CRT) in cancer patients. The role of prophylactic rivaroxaban in this setting remains uncertain.
Methods: We retrospectively analyzed adult cancer patients who underwent peripherally inserted central catheter (PICC) or implantable port (PORT) placement between January 2019 and May 2023. CRT was diagnosed via B-ultrasound. To reduce surveillance bias, only patients who underwent ≥ 4 ultrasound examinations were included. Kaplan–Meier and Cox regression were used to assess the effect of rivaroxaban prophylaxis and to explore subgroup differences.
Results: Among 1,585 patients with upper-limb catheters, 822 met inclusion criteria, with 135 CRT events. The median time to CRT was 55 days (IQR: 29.5– 121.5), and 66.2% occurred within 90 days post-catheterization. Prophylactic rivaroxaban significantly reduced CRT risk (HR = 0.47, 95% CI: 0.33– 0.67; p < 0.001), particularly in high-risk groups such as those with PICC lines or active tumors. No significant benefit was observed in patients with no-evidence-of-disease (NED) or those with cardiac stents, atrial fibrillation, or prior cerebral infarction. In the PORT subgroup, risk reduction was not statistically significant overall (HR = 0.66, p = 0.07), but became significant after excluding NED and cardiovascular conditions (HR = 0.52, p = 0.0195).
Conclusion: Rivaroxaban prophylaxis reduces CRT in cancer patients with long term central venous catheters, particularly those with PICCs or active disease. Routine use appears unnecessary in NED or patients on antiplatelet therapy, highlighting the importance of individualized prophylaxis strategies.
Keywords: anticoagulant, neoplasm, prophylaxis, thrombosis, central venous catheter