From the Guidelines
Xarelto (rivaroxaban) is a reasonable alternative for the treatment of superficial venous thrombosis (SVT) in patients who refuse or are unable to use parenteral anticoagulation, with a suggested dose of 10 mg daily. The treatment of SVT aims to relieve symptoms and prevent extension into the deep venous system, which could lead to more serious complications such as deep vein thrombosis (DVT) or pulmonary embolism (PE) 1. According to the Chest guideline and expert panel report, fondaparinux 2.5 mg daily is the preferred anticoagulant for SVT, but rivaroxaban 10 mg daily is a suitable alternative for patients who cannot use parenteral anticoagulation 1.
The use of anticoagulation in SVT is recommended for 45 days in patients at increased risk of clot progression to DVT or PE 1. The Comparison of Arixtra in Lower Limb Superficial Thrombophlebitis With Placebo (CALISTO) study demonstrated the efficacy of fondaparinux in reducing VTE, recurrent SVT, extension of SVT, and the need for venous surgery, with a low risk of bleeding 1. Additionally, an open-label RCT showed that rivaroxaban 10 mg once daily was noninferior to fondaparinux 2.5 mg once daily in preventing progression of SVT, DVT, PE, or death 1.
Key considerations in the treatment of SVT include:
- Assessment of the extent of thrombosis and proximity to deep veins
- Evaluation of the patient's individual bleeding risk
- Use of anticoagulation for 45 days in patients at increased risk of clot progression
- Consideration of rivaroxaban 10 mg daily as an alternative to fondaparinux in patients who refuse or are unable to use parenteral anticoagulation 1.
From the Research
Superficial Venous Thrombus Treatment with Xarelto
- The treatment of superficial venous thrombosis (SVT) with Xarelto (rivaroxaban) has been evaluated in several studies 2, 3.
- A study published in 2016 described the rationale and design of the SURPRISE trial, which aimed to evaluate the efficacy and safety of rivaroxaban compared to fondaparinux for SVT treatment 2.
- The study found that rivaroxaban may offer advantages for SVT patients, including improved patient adherence and reduced risk of thromboembolic complications.
- A systematic review and meta-analysis published in 2019 found that fondaparinux had the lowest event rate for deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients with SVT, but noted that the evidence for other treatments, including rivaroxaban, was of low quality 3.
- Other studies have evaluated the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and have found that anticoagulation is the mainstay of treatment, with options including low-molecular-weight heparin, vitamin K antagonists, and direct-acting oral anticoagulants such as rivaroxaban 4, 5, 6.
Treatment Options
- Fondaparinux has been shown to have a low event rate for DVT or PE among patients with SVT 3.
- Rivaroxaban has been evaluated as a potential treatment for SVT, but the evidence is limited 2, 3.
- Low-molecular-weight heparin and vitamin K antagonists are commonly used to treat DVT and PE, but may have limitations, such as poor patient adherence and increased risk of bleeding 4, 5, 6.
- Direct-acting oral anticoagulants, including rivaroxaban, may offer advantages for patients with DVT and PE, including improved efficacy and safety profiles 4, 5.