The possibility of administering rivaroxaban prophylaxis to PICC-bound patients

In long-term placement catheters including PICC,Catheter-related thromboembolism (CRT)It is one of the important complications.

In this article, we present a systematic review and meta-analysis examining the efficacy and safety of anticoagulation therapy aimed at preventing CRT in adult cancer patients.

Especially,The possibility of administering rivaroxaban prophylaxis to PICC-bound patientsAnd that’s a piece of news that highlights the limitations of that evidence.

A Systematic Review and Meta-Analysis of Prophylactic Anticoagulation for the Prevention of Catheter-Related Thrombosis in Adult Cancer Patients with Long-Term Central Venous Catheters: Current Evidence, Clinical Uncertainties and Future Directions.
J., Zawadzki, J., & Kudliński, B. (2026): Journal of Clinical Medicine, 15(14), 5566. https://doi.org/10.3390/jcm15145566

[Key points]

• In cancer patients, the risk of blood clot formation associated with long-term indwelling central venous catheters (CVCs), including PICC lines, is high, and catheter-related thrombophlebitis can lead to treatment interruption or catheter removal.
• This paper is a systematic review that examines the effectiveness and safety of preventive anticoagulation therapy for adult cancer patients, including long-term hospitalization in CVC systems, not only for PICC lines but also for CV ports.
• Of these, the preventive administration of rivaroxaban 10 mg to PICC-bound patients was shown to reduce thrombosis; however, this result was based on two non-randomized studies and the evidence was assessed as Very low in certainty.
• The effectiveness of anticoagulants may vary depending on the type of catheter used; results obtained with PICC cannot be generalized to all CVCs. In the future, high-quality randomized controlled trials that clearly distinguish between catheter types are needed.

[Summary and highlights of this paper]

Have you ever had the experience of inserting and managing a PICC in your daily practice and feeling that this patient might develop a blood clot?
While PICC allows for long-term venous access, the catheter itself can cause vascular endothelial damage and blood flow obstruction, and especially in cancer patients, the hypercoagulable state associated with malignant tumors increases the risk of blood clot formation. In fact, catheter-related thrombophlebitis (CRT) not only causes catheter dysfunction but also requires catheter removal and anticoagulation therapy, and sometimes even causes discontinuation of cancer treatment itself.
So, if anticoagulation therapy is administered prophylactically from the time the PICC is placed in, can it reduce the risk of thrombosis?

A systematic review and meta-analysis by Kania et al., published in the Journal of Clinical Medicine in 2026, examined the efficacy and safety of preventive anticoagulation therapy for long-term central venous catheters in adult cancer patients. 16 studies were included, evaluating the prevention of blood clots with low-molecular heparin, warfarin, and direct oral anticoagulants (DOACs).
This paper deals with long-term indwelling catheters, including CV ports and Hickman catheters. Of particular interest is the prevention achieved with PICC and rivaroxaban 10 mg.

In a meta-analysis of five studies by Lv and Sang involving a total of 593 patients with PICC placement, prevention with rivaroxaban was significantly associated with a lower incidence of PICC-related thrombotic events compared with the control group (RR 0.23, 95% CI 0.11–0.48).
On the other hand, it cannot be interpreted as if this result simply means that “patients on PICC line should be given prophylactic administration of rivaroxaban.”
The meta-analysis of rivaroxaban consists of only two studies, and the certainty of the evidence according to the GRADE system is assessed as "Very low". Furthermore, although evaluation has been conducted regarding bleeding, definitions and reporting methods among the studies have not been unified, and a quantitative integrated analysis has not been conducted.

More importantly, it should not be considered as a single entity called “CVC.” The two studies included in the meta-analysis of rivaroxaban targeted PICC, whereas the RCTs for low-molecular heparin targeted a broader range of long-term CVCs. The authors point out that since PICC has a different blood clot risk profile than other long-term retention devices such as CV ports, the results of rivaroxaban should be interpreted in terms of “PICC-related thromboembolism” and should not be generalized to all long-term retention CVCs.

In contrast, the analysis of low molecular heparin in three RCTs, totaling 1,022 cases, showed a directionality to reduce CRT, but did not reach a statistically significant difference (RR 0.77, 95% CI 0.53–1.12).
In the future, they point out the need to homogenize cancer types, catheter types, and anticoagulant therapies as much as possible and to validate them in randomized controlled trials with sufficient detection power.