Hamostaseologie
DOI: 10.1055/a-2918-8110
Authors
Author Affiliations
Lukas Röthlisberger
1
Department of Haematology, University Children's Hospital Zürich (Ringgold ID: RIN30995), Zürich, ZH, Switzerland
2
Faculty of Medicine, University of Zurich (Ringgold ID: RIN27217), Zürich, ZH, Switzerland
Manuela Albisetti
1
Department of Haematology, University Children's Hospital Zürich (Ringgold ID: RIN30995), Zürich, ZH, Switzerland
Alessandra Bosch
1
Department of Haematology, University Children's Hospital Zürich (Ringgold ID: RIN30995), Zürich, ZH, Switzerland
Supported by:
Filling the gap program, University of Zurich, Switzerland
Supported by:
Children’s Research Centre of the University Children’s Hospital Zurich, Switzerland
Supported by:
Walter and Gertraud Siegenthaler Foundation, University of Zurich, Switzerland
Supported by:
Claus Cramer Foundation
A.B. is supported by research grants from the “Claus Cramer Foundation,” “Filling
the gap program” and “Walter and Gertraud Siegenthaler Foundation” from the University
of Zurich, Switzerland, and by the Children’s Research Centre of the University Children’s
Hospital Zurich, Switzerland.
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Abstract
Background Direct oral anticoagulants (DOACs) show increasing popularity in the treatment of
paediatric venous thromboembolism (VTE), but real-world evidence outside clinical
trials remains scarce.
Objectives This study aimed to evaluate the use, safety and effectiveness of rivaroxaban in
a real-world paediatric cohort at a tertiary care hospital.
Methods All children exposed to rivaroxaban between January 2020 and June 2025 at our institution
were included into this single-centre retrospective cohort study. In chart reviews,
effectiveness was assessed as thrombus recurrence, progression, resolution, or improvement;
safety outcomes included clinically relevant bleeding (CRB) and minor bleeding.
Results Fifty-seven children were included at a median age of 13.8 years (IQR 7.1–15.6);
49% were female. In the treatment group (n = 37), one thrombosis recurred (3%), with thrombus resolution in 19 (54%) and radiologic
improvement in 5 patients (14%). In the prophylaxis group (n = 20), no incident VTE occurred. Overall, CRB was rare (7%), all non-major during
rivaroxaban exposure and occurred exclusively in children with identifiable additional
bleeding risk factors.
Conclusions Rivaroxaban demonstrated a favourable effectiveness and safety profile in this real-world
paediatric cohort, with outcomes comparable to available real-world and trial data.
CRB events clustered in settings with additional bleeding risks, underscoring the
importance of patient characteristics in guiding therapy. Our findings support rivaroxaban
as a feasible anticoagulation option in children.
Keywords
adolescent -
child -
infant -
rivaroxaban -
venous thromboembolism
Publication History
Received: 08 May 2026
Accepted after revision: 17 July 2026
Article published online:
29 July 2026
© 2026. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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