De-escalated rivaroxaban in postoperative isolated distal deep vein thrombosis: a propensity score–matched study
- 1Department of Pharmacy, The Second Affiliated Hospital of Dalian Medical University , Dalian, China
- 2Department of Nephrology, The First Affiliated Hospital of Dalian Medical University , Dalian, China
- 3College of Pharmacy, Dalian Medical University , Dalian, China
Abstract
Background: In postoperative isolated distal deep vein thrombosis (IDDVT), anticoagulation intensity is frequently constrained by bleeding risk, which may compromise treatment continuity and clinical effectiveness.
Objectives: To compare the effectiveness and safety of a de-escalated (rivaroxaban 10 mg once daily) versus standard-maintenance rivaroxaban regimen for postoperative IDDVT in a real-world surgical cohort.
Methods: This single-center retrospective cohort study included patients diagnosed with IDDVT following urological surgery between 2013 and 2025. Patients received rivaroxaban at either a low maintenance dose (10 mg once daily) or a standard maintenance dose (20 mg once daily) according to routine clinical practice. Propensity score matching (1:1) was applied to balance baseline characteristics, incorporating surgical approach (endoscopic vs. major structural procedures) as a surrogate for surgical trauma and bleeding risk. The primary outcome was thrombus progression to proximal deep vein thrombosis or pulmonary embolism. Secondary outcomes included IDDVT resolution and clinically relevant non-major bleeding (CRNMB). Competing-risk analyses were performed.
Results: After matching, 152 patients were included (76 per group). Thrombus progression did not differ significantly between groups (subdistribution hazard ratio [SHR] 1.29; 95% CI 0.48–3.46; P = 0.613). No statistically significant difference in IDDVT resolution was detected between the two groups (SHR 0.93; 95% CI, 0.64–1.36; P = 0.721). The low-dose regimen was associated with a significantly lower risk of CRNMB (HR 0.31; 95% CI, 0.11–0.85; P = 0.023) and fewer early bleeding-related treatment interruptions. Early postoperative hematuria was more frequent in the standard-dose group.
Conclusions: In this single-center retrospective cohort of patients with isolated distal deep vein thrombosis after urological surgery, low-dose rivaroxaban (10 mg once daily) was associated with a lower incidence of clinically relevant non-major bleeding than 20 mg once daily. No statistically significant differences were detected between regimens in thrombus progression or complete thrombus resolution. However, these findings should not be interpreted as evidence of equivalent antithrombotic efficacy, given nonrandomized treatment allocation, residual confounding, limited sample size, and wide confidence intervals for thrombotic outcomes. The results are hypothesis-generating and support studies—preferably randomized non-inferiority trials—to determine whether dose de-escalation can provide an acceptable balance between thrombotic protection and bleeding risk in postoperative patients.
Related
- Rivaroxaban prophylaxis and catheter-related thrombosis risk in ambulatory gynecological cancer patients: a retrospective cohort study
- Commentary on “Postoperative complications and mechanical outcomes following endoscopic versus open lumbar fusion: a propensity-matched analysis”
- Postoperative C-Reactive Protein as a Marker of the Early Inflammatory Response in Robotic Versus Laparoscopic Minimally Invasive Surgery for Endometrial Cancer: A Propensity Score-Matched Analysis
- Preoperative Antibiotic Administration Before Distal Radius Fracture ORIF and Postoperative Outcomes: A Propensity-Matched Cohort Study
- Anticoagulant Prophylaxis with Edoxaban for Asymptomatic Isolated Distal Deep Vein Thrombosis in Perioperative Hip Fracture Patients.
BibTeX
@article{bai2026deescalated,
title = {{De-escalated rivaroxaban in postoperative isolated distal deep vein thrombosis: a propensity score–matched study}},
author = {Hansheng Bai and Qingzhu Tang and Linhao Jin and Mengqi Yang and Guangjun Fan and Si Wu},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1855986},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1855986/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - De-escalated rivaroxaban in postoperative isolated distal deep vein thrombosis: a propensity score–matched study
AU - Hansheng Bai
AU - Qingzhu Tang
AU - Linhao Jin
AU - Mengqi Yang
AU - Guangjun Fan
AU - Si Wu
PY - 2026
DA - 2026/10/19
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1855986
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1855986/full
AB - Background: In postoperative isolated distal deep vein thrombosis (IDDVT), anticoagulation intensity is frequently constrained by bleeding risk, which may compromise treatment continuity and clinical effectiveness. Objectives: To compare the effectiveness and safety of a de-escalated (rivaroxaban 10 mg once daily) versus standard-maintenance rivaroxaban regimen for postoperative IDDVT in a real-world surgical cohort. Methods: This single-center retrospective cohort study included patients diagnosed with IDDVT following urological surgery between 2013 and 2025. Patients received rivaroxaban at either a low maintenance dose (10 mg once daily) or a standard maintenance dose (20 mg once daily) according to routine clinical practice. Propensity score matching (1:1) was applied to balance baseline characteristics, incorporating surgical approach (endoscopic vs. major structural procedures) as a surrogate for surgical trauma and bleeding risk. The primary outcome was thrombus progression to proximal deep vein thrombosis or pulmonary embolism. Secondary outcomes included IDDVT resolution and clinically relevant non-major bleeding (CRNMB). Competing-risk analyses were performed. Results: After matching, 152 patients were included (76 per group). Thrombus progression did not differ significantly between groups (subdistribution hazard ratio [SHR] 1.29; 95% CI 0.48–3.46; P = 0.613). No statistically significant difference in IDDVT resolution was detected between the two groups (SHR 0.93; 95% CI, 0.64–1.36; P = 0.721). The low-dose regimen was associated with a significantly lower risk of CRNMB (HR 0.31; 95% CI, 0.11–0.85; P = 0.023) and fewer early bleeding-related treatment interruptions. Early postoperative hematuria was more frequent in the standard-dose group. Conclusions: In this single-center retrospective cohort of patients with isolated distal deep vein thrombosis after urological surgery, low-dose rivaroxaban (10 mg once daily) was associated with a lower incidence of clinically relevant non-major bleeding than 20 mg once daily. No statistically significant differences were detected between regimens in thrombus progression or complete thrombus resolution. However, these findings should not be interpreted as evidence of equivalent antithrombotic efficacy, given nonrandomized treatment allocation, residual confounding, limited sample size, and wide confidence intervals for thrombotic outcomes. The results are hypothesis-generating and support studies—preferably randomized non-inferiority trials—to determine whether dose de-escalation can provide an acceptable balance between thrombotic protection and bleeding risk in postoperative patients.
SN - 2297-055X
ER -