rivaroxaban / Generic mfg. - LARVOL DELTA

Is there a role for anticoagulation with dabigatran in S. aureus bacteremia? Protocol for the adjunctive treatment domain of the Staphylococcus aureus Network Adaptive Platform (SNAP) randomised controlled trial. (PubMed, BMJ Open) - P4 | "Oral factor Xa inhibitors (oral FXaI, eg, apixaban, edoxaban or rivaroxaban) are commonly prescribed for this indication. The trial is registered at clinicaltrials.gov with the identifier NCT06650501. NCT0665050."

Clinical protocol • Journal • Atrial Fibrillation • Cardiovascular • Infectious Disease • Venous Thromboembolism

Optimizing PNH treatment with the complement inhibitor pegcetacoplan: A case report (ASH 2025) - "The current treatment landscape includes 6 approved complement cascade inhibitors: 3 C5 inhibitors (eculizumab, ravulizumab, crovalimab), 1 C3/C3b inhibitor (pegcetacoplan), 1 factor B inhibitor (iptacopan), and 1 factor D inhibitor used as add-on treatment (danicopan)...Concomitant medications included apixaban, penicillin, and folic acid. In November 2020, her platelets count declined, and a bone marrow evaluation was diagnostic for moderate aplastic anemia (55-65% cellularity for age) and she was started on eltrombopag and cyclosporin. Despite ravulizumab and eltrombopag treatments, the patient developed significant anemia related to extravascular hemolysis (hemoglobin, 5.7 g/dL; LDH, 495 U/L; C5, 26.1 mg/dL [high]; complement hemolytic activity 50 [CH50], 7 U/mL [low])...After receiving both pegcetacoplan and iptacopan for 1 week and rivaroxaban 10 mg once daily for 48 hours, pegcetacoplan treatment ended on May 16, 2024... For this patient with PNH, the..."

Case report • Clinical • Anorexia • Aplastic Anemia • Complement-mediated Rare Disorders • Hematological Disorders • Infectious Disease • Meningococcal Infections • Paroxysmal Nocturnal Hemoglobinuria • Rare Diseases

Efficacy and safety of low-dose vs. standard-dose direct oral anticoagulants for secondary prevention of cancer associated thrombosis: A systematic review and meta-analysis (ASH 2025) - " We performed a meta-analysis of randomized controlled trials (RCTs) and retrospective and prospective observational studies evaluating reduced-dose apixaban (2.5 mg twice daily) or rivaroxaban (10 mg once daily), compared with standard-dose (5 mg twice daily for apixaban, 20 mg once daily for rivaroxaban) for the extended treatment of VTE. Extended-duration anticoagulation with reduced-dose DOACs in patients with active cancer demonstrated non-inferior efficacy for preventing recurrent VTE compared to full-dose regimens, with no significant differences in all-cause mortality, major bleeding, or clinically relevant non-major bleeding. In a randomized trial subgroup analysis, reduced-dose DOACs were associated with a lower risk of composite bleeding. These findings support the consideration of reduced-dose DOACs as a safer alternative for long-term anticoagulation in cancer patients."

Retrospective data • Review • Oncology • Thrombosis • Venous Thromboembolism

efficacy and safety of direct oral anticoagulants versus low-molecular-weight heparin for recurrent VTE in cancer patients: A grade-assessed comprehensive meta-analysis of expanded outcomes from randomized controlled trials. (ASH 2025) - "Subgroup analyses showed varying effects among different DOAC agents, with the greatest benefit in preventing recurrent VTE seen in the rivaroxaban subgroup... Twelve studies involving a total of 8,925 patients were analyzed. The use of DOACs was associated with a significant reduction in the risk of VTE recurrence (RR: 0.70, 95% CI: 0.58-0.83), with no notable increase in major bleeding risk (RR: 1.08, 95% CI: 0.79-1.48). No significant differences were observed in CRNMB incidences, all-cause mortality, or PE."

Retrospective data • Oncology • Respiratory Diseases • Venous Thromboembolism

Real-world comparative bleeding outcomes of direct oral anticoagulants versus warfarin in adults: Insights from observational evidence (ASH 2025) - "Background: Direct oral anticoagulants (DOACs) – apixaban, rivaroxaban, dabigatran, and edoxaban– are increasingly preferred over warfarin for stroke prevention in atrial fibrillation and treatment of venous thromboembolism. This review provides robust real-world evidence that DOACs offer a superior safety and effectiveness profile compared to warfarin in adult patients requiring anticoagulation. DOACs significantly reduce the incidence of ICH and stroke– two of the most clinically devasting complications– while maintaining comparable or lower rates of major and GI bleeding. These findings validate guideline recommendations and strongly support the preferential use of DOACs as the standard of care for anticoagulation in everyday clinical practice."

Clinical • Real-world • Real-world evidence • Atrial Fibrillation • Cerebral Hemorrhage • CNS Disorders • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Venous Thromboembolism

When pregnancy, HIT, and stroke collide: Navigating complex thrombotic care in a community-based setting (ASH 2025) - "Case Presentation: A 30-year-old woman, gravida 1 para 0, with a history of unprovoked lower extremity deep vein thrombosis (DVT) on chronic rivaroxaban for secondary prophylaxis was transitioned to low-molecular-weight heparin (enoxaparin) upon confirmation of pregnancy at 7 weeks' gestation...Enoxaparin was discontinued, and argatroban was initiated post-EVT, later transitioning to subcutaneous danaparoid, and ultimately fondaparinux for the remainder of her pregnancy...Another important feature of this case is that it was successfully managed entirely within a regional community hospital system, allowing the patient to stay close to her family and access local rehabilitation services. This case report highlights the ability of community-based hospitals to provide high-acuity, patient-centered care through strong interdisciplinary collaboration."

Cardiovascular • Hematological Disorders • Infectious Disease • Novel Coronavirus Disease • Thrombocytopenia • Thrombosis

Inferior vena cava agenesis presenting as iliofemoral deep vein thrombosis in a 49-year-old male (ASH 2025) - "Case Presentation We present the case of a 49-year-old man with a past medical history of hypertension managed with losartan and impaired glucose tolerance treated with metformin...He was started on enoxaparin and later transitioned to rivaroxaban for outpatient anticoagulation...Conclusion This case underscores the diagnostic and therapeutic challenges in managing iliofemoral DVT due to IVC agenesis. Early identification and intervention can lead to favorable outcomes, particularly with the use of endovascular techniques and comprehensive follow-up."

Cardiovascular • CNS Disorders • Developmental Disorders • Hematological Disorders • Hypertension • Thrombosis • Venous Thromboembolism

Vmx-C001 has no effect on the anticoagulant function of heparin in healthy subjects (ASH 2025) - "This study tested the anticoagulant effects of UFH and LMWH administered shortlyafter VMX-C001 in healthy subjects in situations simulating (a) patients taking FXa DOACs who requirerestoration of coagulation with VMX-C001 and then require UFH, e.g., for cardiopulmonary bypass; and(b) patients receiving VMX-C001 who then require LMWH for thromboprophylaxis. This Phase I, single site, open-label study in healthy subjects (aged ≥18–49 years) investigatedthe effects of VMX-C001, in combination with the FXa DOAC rivaroxaban and alone, on the anticoagulanteffect of UFH (UFH cohort) and LMWH (enoxaparin; LMWH cohort), respectively. In the UFH cohort (N=7), mean age was 28±8 years, 5 (71.4%) were female and all were non-Hispanic white. Following UFH alone on day 1, changes from baseline at 1 hr post-UFH: PT, aPTT and ACTincreased, dPT +16.41 sec and dRVVT -2.85 sec; TG decreased to undetectable levels (-100% vs. baseline).Four hrs after rivaroxaban administration on day 4:..."

Clinical • TINCR

Is there an optimal time to transition to low dose direct oral anticoagulants? (ASH 2025) - "Background : Prophylactic-dose or low-dose apixaban and rivaroxaban have been studied in randomizedcontrolled trials for the extended prevention of venous thromboembolism (VTE) after 6 months oftreatment with therapeutic anticoagulation. This real-world patient population demonstrates that anticoagulant prescribers transition tolow-dose DOACs ahead of the historically studied 6-month time point. The results of this study do notindicate a significant difference in clinical outcomes of VTE recurrence or bleeding complications basedon time of transition to low-dose DOACs either before or after 6 months."

Venous Thromboembolism

Rivaroxaban in pediatric venous malformations complicated by thrombosis: Updated experience from a retrospective single-center cohort (ASH 2025) - "In additionto its favorable safety profile, oral administration and lack of monitoring requirements make rivaroxabana practical option in this population. Further prospective studies are needed to validate its efficacy insymptom control and thrombosis resolution in this unique patient group."

Retrospective data • Alopecia • Cardiovascular • Gastrointestinal Disorder • Gynecology • Hematological Disorders • Immunology • Pediatrics • Thrombosis • Venous Thromboembolism

Abbreviated anticoagulation regimen with direct oral anticoagulants is safe and efficacious in the management of infection-associated cerebral sinovenous thrombosis in children (ASH 2025) - "Forty-five (96%) patients were started on unfractionated heparin (UFH) orlow molecular weight heparin, and 15 (32%) were transitioned to rivaroxaban or apixaban. One patient died of an underlying malignancy.ConclusionOur data suggests that an abbreviated course of anticoagulation using DOACs is safe and efficacious inthe management of infection-associated CSVT in children. Additionally, thrombophilia work-up is lowyield and likely not indicated in this cohort."

Clinical • Cardiovascular • Infectious Disease • Otorhinolaryngology • Respiratory Diseases • Sinusitis • Thrombosis • Venous Thromboembolism

Extended duration anticoagulation in cancer associated thrombosis (ASH 2025) - "Prophylactic dose of anticoagulation wasdefined as apixaban 2.5mg BD, rivaroxaban 10mg OD or enoxaparin 40mg OD (20mg OD for weight<50kg). Low dose anticoagulation is used in clinical practice for secondary thromboprophylaxis in patients withCAT without a signal for increased VTE recurrence and with low bleeding complications. Further data arerequired on the longer-term continuation of this thromboprophylactic strategy in an era when patientsare living longer with advanced cancer."

Oncology • Thrombosis

primary thromboprophylaxis using direct oral anti-coagulants (DOAC) in malignant pediatric tumors with vascular compression (ASH 2025) - "Sarangi previously demonstrated a reduction inthrombotic events for patients with mediastinal masses and tumor-related vascular compression (TRVC)who received prophylactic enoxaparin (Sarangi et...Fourteen patients (≥12 years and >40 kg) receivedapixaban (2.5 mg twice a day) and 5 patients received rivaroxaban (weight-based dosing)...On apixaban, 1 patient had rapid self-resolution of epistaxis, and another had hematuria withconcurrent ifosfamide administration...Though limited by its mostly retrospective design, small sample size, and single-institution population,our study highlights an at-risk subgroup of pediatric oncology patients with TRVC that may benefit fromuniversal primary thromboprophylaxis with a DOAC. Larger studies are needed to evaluate this further."

Clinical • Desmoid Tumors • Fibrosis • Hematological Malignancies • Lymphoma • Neuroblastoma • Obesity • Oncology • Pediatrics • Sarcoma • Solid Tumor • Venous Thromboembolism

Efficacy and safety of low-dose vs. standard-dose direct oral anticoagulants for secondary prevention of venous thromboembolism: A systematic review and meta-analysis (ASH 2025) - "This meta-analysisevaluates the efficacy and safety of reduced-dose versus standard-dose DOACs for extended VTEtreatment in the general population, high-risk subgroups, and patients with clinical equipoise regardingthe continuation of anticoagulation.We conducted a meta-analysis of randomized controlled trials (RCTs) evaluating reduced dose apixaban(2.5 mg twice daily) or rivaroxaban (10 mg once daily), compared to their respective standard dose (5 mgtwice daily for apixaban, 20 mg once daily for rivaroxaban) for the extended treatment of venousthromboembolism (VTE). Reduced-dose DOACs appear to preserve efficacy while significantly lowering bleeding risk compared tostandard-dose regimens for extended VTE treatment. These benefits were consistent across studiedclinical subgroups, although a possible sex-based interaction was observed for VTE recurrence. Thesefindings support the use of reduced-dose DOACs as a safer alternative for extended anticoagulation andhighlight..."

Retrospective data • Review • Cardiovascular • Hematological Disorders • Respiratory Diseases • Venous Thromboembolism

Comparative effectiveness and safety of apixaban vs. rivaroxaban in patients with cirrhosis and portal vein thrombosis: An analysis of real-world data (ASH 2025) - "Anticoagulation is recommended to treat PVT despite low-certaintyevidence, largely derived from studies of heparin and warfarin. In this real-world cohort of patients with cirrhosis and PVT, apixaban and rivaroxaban were associatedwith similar effectiveness. Use of apixaban was associated with a lower incidence of bleeding thanrivaroxaban, although the CI included the null value of one. These findings are consistent with itsfavorable pharmacokinetic profile in hepatic impairment and with observations in other populations."

Clinical • HEOR • Real-world • Real-world evidence • Atrial Fibrillation • Biliary Cancer • Cardiovascular • Cerebral Hemorrhage • Chronic Kidney Disease • CNS Disorders • Fibrosis • Gastrointestinal Disorder • Hepatology • Immunology • Liver Cirrhosis • Liver Failure • Nephrology • Renal Disease • Thrombosis • Venous Thromboembolism

Risk of bleeding in chronic lymphocytic leukemia patients in remission treated with covalent Bruton tyrosine kinase inhibitors and contemporary anticoagulant or antiplatelet drugs: Real-world data analysis (ASH 2025) - "The study population was divided into two main cohorts: 1) Cohort 1: CLLpatients in remission treated with covalent BTKi (ibrutinib/acalabrutinib/zanubrutinib) concurrentlytreated with AC (rivaroxaban/apixaban/edoxaban/dabigatran) or AP agents (acetylsalicylicacid/clopidogrel/prasugrel/ticagrelor/ticlopidin), and 2) Cohort 2: CLL patients in remission treated withcovalent BTKi (ibrutinib/acalabrutinib/zanubrutinib) not concurrently treated with AC or AP agents.Cohort 1 was further subdivided into two groups: those treated only with AC and those treated only withAP. CLL patients in remission treated with covalent BTKis experience a significant risk ofbleeding events. This risk is substantially elevated when covalent BTKis therapy is combined with eitheranticoagulant or antiplatelet agents. Notably, our findings indicate no discernible difference in bleedingrisk between AC or AP agents when used concurrently with covalent BTKis."

Clinical • Real-world • Real-world evidence • Chronic Lymphocytic Leukemia • Hematological Disorders • Hematological Malignancies • Leukemia

primary prophylaxis with direct oral anticoagulants (DOACs) for transwomen taking estrogen is not cost-effective (ASH 2025) - "TW without a personal history of VTE were assumed to start DOAC prophylaxis (i.e.apixaban 2.5mg BID or rivaroxaban 10mg daily) with oral GAHT (i.e. 2mg daily of oral estradiol). At known TW-specific VTE rates and current DOAC pricing, DOAC prophylaxis is not a cost-effective strategy for adult TW patients receiving GAHT."

Cost effectiveness • HEOR • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Venous Thromboembolism

Outcomes and resource utilization during and after oral anticoagulant-related bleeding in chronic kidney disease (ORACLE-CKD): A population-based cohort study (ASH 2025) - "We accrued patients ≥66 years who were hospitalized for bleedingand had an OAC (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin) dispensed precedingadmission (April 2012 to March 2022). Patients hospitalized with OAC-related bleeding are at high risk of death during andimmediately following hospitalization. Mortality risk was greater among patients with CKD. Within 1 yearof hospital discharge, three-quarters of patients with moderate or severe CKD visited the ED, and overhalf were readmitted to hospital."

Clinical • HEOR • Alzheimer's Disease • Atrial Fibrillation • Chronic Kidney Disease • CNS Disorders • Congestive Heart Failure • Dementia • Gastroenterology • Heart Failure • Ischemic stroke • Myocardial Infarction • Nephrology • Renal Disease • Respiratory Diseases • Venous Thromboembolism

Apixaban or rivaroxaban for extended anticoagulation in patients with venous thromboembolism: A post hoc analysis of the renove clinical trial (ASH 2025) - "In this post hoc analysis of the strata of a large RCT of patients with VTE who had completedat least 6 months of full-dose anticoagulation and had an indication for extended treatment, apixabanand rivaroxaban showed similar safety profiles at 5 years, both in the full- and reduced-dose subgroupscomparisons, while dose reduction showed similar benefit on CRB risk with both drugs. In contrast withthe first months of full-dose anticoagulation, rivaroxaban proved as safe as apixaban during extendedtreatment, whether at full or reduced dose. Ideally, these results would need to be confirmed in a specificrandomized trial."

Clinical • Retrospective data • Cardiovascular • Venous Thromboembolism

Systematic review and meta-analysis of randomized controlled trials on outpatient thromboprophylaxis (OTP) in patients with cancers with khorana score (KS) ≥ 2 receiving chemotherapy (ASH 2025) - "The prophylactic, intermediate and therapeutics doses of LMWHs (prophylacticdoses in PROTECHT and SAVE-ONCO trials, therapeutic/intermediate doses in FRAGEM and CONKO-004trials), and prophylactic doses of DOAC (rivaroxaban in CASSINI, and apixaban in AVERT trials) were usedin the studies. OTP in patients with cancers with KS ≥ 2 may statistically significantly decrease venousthromboembolism events, approximately with relative risk reduction of 59% and a NNT of 20 in overallpopulation while relative risk reduction of 80% with a NNT of 16 in patients receiving LMWH. The effectwas more pronounced in patients receiving either intermediate or therapeutic dose of LMWH (relativerisk reduction of 92% with a NNT of 9). One weakness of our study is that we could not get KS data fromthe patients in the SAVE-ONCO and PROTECHT trials except those with gastric and pancreas cancers.Although OTP in patients with cancers with KS ≥ 2 is currently suggested by clinical practice..."

Retrospective data • Review • Gastric Cancer • Oncology • Pancreatic Cancer • Solid Tumor • Venous Thromboembolism

Risk of serious bleeding with concomitant use of apixaban or rivaroxaban with amiodarone compared to flecainide or sotalol in patients with atrial fibrillation (ASH 2025) - "Covariates were well balanced post-matching (standardized differences <0.1).After matching, 253 patients in the amiodarone group experienced serious bleeding (25.8 events per1,000 person-years) compared to 175 in the comparator group (16.4 events per 1,000 person-years) (HR,1.53; 95% CI, 1.26 to 1.86).CONCLUSIONIn this comparative safety study, among patients with AF treated with apixaban or rivaroxaban,concomitant use of amiodarone was associated with a higher risk of serious bleeding compared to use offlecainide or sotalol. These findings highlight the importance of considering drug-drug interactions whenmanaging anticoagulated patients with AF to promote safe prescribing and minimize the risk of seriousbleeding complications."

Clinical • Asthma • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Hepatology • Immunology • Nephrology • CYP3A4 • PER1

Comparing the safety of direct oral anticoagulants vs. low-molecular-weight heparin in patients with thrombocytopenia and venous thromboembolism (ASH 2025) - "In the DOAC cohort, 11 patients receivedApixaban and 3 received Rivaroxaban... Based on our preliminary data from a single-institutional cohort study, composite outcomeswere higher among patients on DOAC compared to LMWH (29.8% vs. 13.6%), but the difference did notmeet statistical significance. LMWH cohort notably only had 3 CRNMB without any MB or new VTE.Despite increasing clinical use of DOAC, our study provides a signal for a better safety profile for LMWHin patients with TCP."

Clinical • Cardiovascular • Respiratory Diseases • Thrombocytopenia • Venous Thromboembolism

Risk of venous and arterial thromboembolic events following CAR-T therapy in relapsed or refractory non-Hodgkin lymphoma: A propensity-matched multicenter analysis. (ASH 2025) - "The CAR-T cohort included patients who received anyFDA-approved CAR-T product (axi-cel, tisa-cel, liso-cel)...Propensity score matching (1:1, nearest neighbor, caliper 0.1) was performed to balance baselinecharacteristics, including age, sex, race, hypertension, diabetes, hyperlipidemia, chronic ischemic heartdisease, chronic kidney disease (all stages), atrial fibrillation, prior ischemic heart disease, priorthromboembolic events, and use of aspirin, warfarin, apixaban, clopidogrel, ticagrelor, or rivaroxabanbefore CAR-T cell therapy... In this large propensity score–matched analysis of patients with relapsed or refractory NHL, CAR-Ttherapy was associated with a substantially higher 90-day risk of venous thromboembolism and acutelimb ischemia in the early post–CAR-T period. These findings highlight the need for close clinicalmonitoring and the potential role of preventive strategies, such as the use of prophylacticanticoagulation in patients with a low risk of bleeding."

Clinical • Atrial Fibrillation • B Cell Lymphoma • Chronic Kidney Disease • CNS Disorders • Coronary Artery Disease • Diabetes • Diffuse Large B Cell Lymphoma • Dyslipidemia • Follicular Lymphoma • Heart Failure • Hematological Disorders • Hematological Malignancies • Hypertension • Ischemic stroke • Lymphoma • Myocardial Infarction • Nephrology • Non-Hodgkin’s Lymphoma • Respiratory Diseases • Venous Thromboembolism

Cost effectiveness of in-house HIT screening testing in community based hospital (ASH 2025) - "Empiric anticoagulation was initiated in 147 (28.8%) patients, withargatroban in 85 (57.8%), fondaparinux in 50 (34.0%), and 12 (8.2%) receiving other anticoagulants(apixaban, rivaroxaban, or bivalirudin)...Only 48 (18.6%) patients received empiricanticoagulation, with argatroban used in 25 (52.1%), fondaparinux in 17 (35.4%), and otheranticoagulants (apixaban and bivalirudin) in 6 (12.5%)...Theimplementation of in-house HIT screening tests resulted in an annual cost saving of $17,181 inanticoagulation alone. ConclusionImplementation of the HIT testing algorithm using an in-house screening test with a reflex outsourcedconfirmatory test resulted in decreased turnaround time, reduction of empiric anticoagulation utilization,and potential cost savings for hospitalized patients with suspected HIT."

Clinical • Cost effectiveness • HEOR • Hematological Disorders • Thrombocytopenia

Impact of thrombocytopenia on hemorrhage and recurrent thrombosis in patients with cancer associated thrombosis, a time varying analysis (ASH 2025) - "Most patients (89.8%) received anticoagulation following theirindex VTE, including apixaban (51.4%), enoxaparin (29.0%) and rivaroxaban (8.5%). The severity ofthrombocytopenia directly parallels the risk of major bleeding and thrombotic recurrence, yet even mildreductions in platelet count markedly elevate these risks. Incorporating thrombocytopenia into risk-stratification tools and tailoring anticoagulation strategies accordingly will be essential for safelymanaging this frequent clinical challenge."

Clinical • Gastric Cancer • Gastrointestinal Cancer • Hepatology • Nephrology • Oncology • Renal Disease • Respiratory Diseases • Solid Tumor • Thrombocytopenia • Thrombosis • Venous Thromboembolism