Efficacy of Rivaroxaban in Children with Short Bowel Syndrome

Introduction: Patients with short bowel syndrome (SBS) require lifelong parenteral nutrition via a central venous catheter. The majority of patients develop recurrent catheter-related thrombosis or occlusion of the corresponding veins during their lifetime, leading to frequent catheter replacement. However, as this becomes increasingly difficult over time due to vascular occlusion, safe and effective prophylactic anticoagulation is essential.To date, there is limited data regarding the efficacy of Rivaroxaban in children with SBS.

Method: This report presents the two center experiences of 3 SBS patients receiving anticoagulation with Rivaroxaban.

Results:Patient 1 is a 11-year old girl with a residual length of 45 cm of short bowel and total parenteral nutrition since the age of 2. She had 4 central venous lines (Hickman) up to now and experienced thrombosis of right subclavian vein 2022. The original anticoagulation with Dalteparin was changed to Rivaroxaban in 8/2023.

Patient 2 is a 15-year-old male with a residual length of 61 cm of short bowel caused by atresia of jejunum, intrauterine volvulus and microcolon. He presented with progressive thrombosis of the right subclavian and internal jugular veins and a high-grade stenosis of the distal superior vena cava (SVC), for which stent angioplasty was performed in July 2023. Following the intervention, patient was treated with ASA and LMWH and then switched to Rivaroxaban in January 2024

Patient 3 is a 5-year-old girl with a residual length of 10 cm caused by subtotal resection due to a small bowel volvulus. She suffered recurrent catheter-associated thromboses, resulting in congestion of the upper vena cava. Initially, therapeutic anticoagulation with LMWH was performed, followed by Vitamin K antagonist January 2023 to May 2024, and then switch to Rivaroxaban. The dose of VKA required to achieve a target INR was higher than typically observed in children of similar weight.The switch to Rivaroxaban was performed with weight adapted standard dose, covered with prophylactic low-molecular-weight heparin for the first days. The Rivaroxaban level and D-dimers were monitored regularly, and the dose was adjusted based on these values. Patients 1 and 3 reached levels within the target range with standard-dose, without an increase in D-dimers. Due to insufficient levels with standard dose (1x20 mg), dose of patient 2 had to be adjusted to 2x15 mg. With this dosage, the level was within the target range without an increase in D-dimers.

Conclusion: In conclusion, anticoagulation with Rivaroxaban appears to be a safe alternative in patients with SBS. In this patient group, regular level measurements and, if necessary, dose adjustments should be performed, specifically since higher doses may be required in some cases. However, the limited observation period and the relatively small number of patients included in the current analysis must be considered as potential limitations.

 

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Conflict of Interest:

Wieland: Investigator in clinical trials sponsored by Pfizer, Roche/Chugai, Sobi; Consultant for: Bayer, Biotest, CSL Behring, Novo Nordisk, Octapharma, Pfizer, Roche/Chugai, Shire/Takeda, and Sobi Becker: non

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2025