American Society of Hirudotherapy

Rivaroxaban and apixaban are less effective than enoxaparin for the prevention of catheter-induced clotting in vitro

Research article published in Journal of thrombosis and haemostasis : JTH (2022)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Research reportClinical LiteratureGuan Z et al. · Journal of thrombosis and haemostasis : JTH, 2023

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.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleResearch Support, Non-U.S. Gov't
Indexed MeSH termsHumansEnoxaparinRivaroxabanAnticoagulantsThrombinPyridonesHeparin, Low-Molecular-WeightThrombosisCathetersNeoplasmsFactor Xa InhibitorsPyrazoles

Summary

In human plasma, catheter segments promoted clotting and thrombin generation; at concentrations with matched anti-factor Xa activity, apixaban and rivaroxaban were over 20-fold less potent than enoxaparin at preventing this.

Context

This in vitro study compared apixaban, rivaroxaban, and enoxaparin for prevention of catheter-induced clotting and thrombin generation in human plasma using a microplate-based assay, finding that the direct oral anticoagulants were >20-fold less potent than enoxaparin at equivalent anti-factor Xa activity. The study highlights ongoing challenges in preventing catheter thrombosis, particularly in cancer patients. The study examines synthetic oral anticoagulants and low-molecular-weight heparin with no involvement of leeches, hirudin, or any leech-secretome component. This is an in vitro plasma assay with no leech-related content.

Citation

Reference (Vancouver style)

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;21(1):76-82. doi:10.1016/j.jtha.2022.10.020. PMID: 36695399

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

DOIPubMed

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