Rivaroxaban and apixaban are less effective than enoxaparin for the prevention of catheter-induced clotting in vitro

Central venous catheters are prone to clotting, particularly in patients with cancer. Although low-molecular-weight heparin and direct oral anticoagulants, such as apixaban and rivaroxaban, have been evaluated for the prevention of catheter thrombosis, their efficacy remains uncertain. Compare apixaban and rivaroxaban with enoxaparin for the prevention of catheter-induced clotting in vitro. To address this uncertainty, we used a well-established microplate-based assay to compare the effects of enoxaparin, apixaban, and rivaroxaban on catheter-induced thrombosis and thrombin generation in human plasma. Consistent with our previous findings, catheter segments shortened the clotting time and promoted thrombin generation. When compared at concentrations with similar anti-factor Xa activity as enoxaparin, apixaban and rivaroxaban were >20-fold less potent than enoxaparin for the prevention of catheter-induced clotting and thrombin generation. The prevention of catheter thrombosis in patients with cancer is challenging. Clinical trials are needed to compare the efficacy of low-molecular-weight heparin with that of direct oral anticoagulants both for the prevention and treatment of catheter thrombosis. •Central venous catheters are prone to clotting, and prevention is challenging.•Effects of enoxaparin, apixaban, and rivaroxaban on catheter-induced clotting were examined.•Apixaban and rivaroxaban were 20-fold less potent than enoxaparin in the prevention of clotting.•Clinical trials are needed to evaluate anticoagulants in preventing catheter-induced clotting.