Low Dose Rivaroxaban as Extended Prophylaxis Reduces Postdischarge Venous Thromboembolism in Patients With Malignancy and Inflammatory Bowel Disease

Abstract

BACKGROUND: Despite guidelines suggesting the use of extended prophylaxis for prevention of venous thromboembolism in patients with colorectal cancer and perhaps inflammatory bowel disease, routine use is low and scant data exist regarding oral forms of therapy. OBJECTIVE: The purpose was to compare the incidence of postdischarge venous thromboembolism in patients given extended prophylaxis with low dose rivaroxaban. DESIGN: We used propensity matching to compare a pre- and postintervention analysis from a 2-year period prior to instituting extended prophylaxis. SETTING: All colorectal patients at a single institution were prospectively considered for extended prophylaxis. PATIENTS: Patients with a diagnosis of inflammatory bowel disease or colorectal cancer who underwent operative resection were included. INTERVENTIONS: Those considered for extended prophylaxis were prescribed 10 mg of rivaroxaban for 30 days post-surgery. MAIN OUTCOME MEASURES: The primary outcome was venous thromboembolism incidence 30-days post-discharge. The secondary outcome was bleeding rates, major or minor. RESULTS: Of the 498 patients considered for extended prophylaxis, 363 were discharged with rivaroxaban, 81 on baseline anticoagulation, and 54 without anticoagulation. Propensity matched cohorts based on stoma creation, operative approach, procedure type and body mass index, were made to 174 historical controls. After excluding cases of inpatient venous thromboembolism, postoperative rates were lower in the prospective cohort (4.8% vs 0.6%, p = 0.019). In the prospective group 36 episodes of bleeding occurred, 26 (7.2%) discharged with rivaroxaban, 8 (9.9%) discharged on other anticoagulants and 2 (3.7%) with no postoperative anticoagulation. Cases of major bleeding were 1.1%, (4/363) in the rivaroxaban group and each required intervention. LIMITATIONS: The study was limited to a single institution and did not include a placebo arm. CONCLUSIONS: Among patients with inflammatory bowel disease and colorectal cancer, extended prophylaxis with low dose rivaroxaban led to a significant decrease in post-discharge thromboembolic events with a low bleeding risk profile