2025 Southeastern Residency Conference

Title: Evaluation of Venous Thromboembolism Prophylaxis in Conjunction with Low Dose Rivaroxaban in Hospitalized Patients
 
Authors: Kara Bamberger, Matt Wallace, Regan Wade
 
Background: Acute venous thromboembolism (VTE) is a common, preventable complication in hospitalized patients that contributes to significant morbidity and mortality. Current guidelines recommend the use of unfractionated heparin (UFH), low molecular weight heparin (LMWH), or fondaparinux for pharmacologic prophylaxis in hospitalized patients at risk of developing VTE. Alternatively, rivaroxaban, an oral factor Xa inhibitor, can be utilized as VTE prophylaxis at a dose of 10 mg daily. Rivaroxaban is also approved for the indications of stable coronary artery disease (CAD), recent acute coronary syndrome (ACS), and peripheral artery disease (PAD) at a lower dose of 2.5 mg twice daily, in conjunction with aspirin at doses less than 100 mg daily. However, its VTE prophylactic benefits at this dosing in hospitalized patients is unclear, making the need for additional pharmacologic VTE prophylaxis uncertain. At Vanderbilt University Medical Center (VUMC), the practice for mitigating VTE risk among these patients is not standardized. 
 
Methods: A retrospective, single-center cohort study was conducted to evaluate the safety and efficacy of administering pharmacologic VTE prophylaxis in conjunction with low dose rivaroxaban in hospitalized patients. Patients were eligible for inclusion if they were 18 years of age or older, admitted to VUMC for at least 24 hours, administered at least one dose of low dose rivaroxaban, and had an indication for VTE prophylaxis based on a PADUA prediction score of ≥4. Patients were excluded if they had established an VTE event prior to inclusion, were receiving or had an indication for therapeutic anticoagulation, or a contraindication to VTE prophylaxis. The primary outcome evaluated was a composite of new VTE events during hospitalization and clinically significant bleeding events. Secondary outcomes evaluated were hospital length of stay and the time to initiation of VTE prophylaxis after admission.
 
Results: In progress
 
Conclusions: In progress