SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Efficacy and safety of Rivaroxaban in patients with an inferior vena cava filter: a systematic review and meta-analysis
Guoliang Wang 1
Peng Ji 1
Huagang Li 1
Hongzhi Sun 1
Lei Qi 2
1. Anhui Medical University, Hefei, China
2. University of Shanghai for Science and Technology, Shanghai, China
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Abstract
Background The optimal anticoagulation strategy following inferior vena cava (IVC) filter placement remains uncertain, particularly for patients with non-retrieved filters. Rivaroxaban, a direct oral anticoagulant (DOAC), offers practical advantages over vitamin K antagonists (VKAs), but evidence regarding its use in this subgroup is limited. We aimed to evaluate the efficacy and safety of rivaroxaban in patients with IVC filters compared with conventional VKA therapy. Methods This systematic review and meta-analysis followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251165963). A comprehensive search of PubMed, Web of Science, Embase, and Scopus was conducted up to September 30, 2025. Eligible studies included adult patients with IVC filter implantation receiving rivaroxaban versus VKAs or other anticoagulants, reporting outcomes of venous thromboembolism (VTE), bleeding, filter-related complications, or mortality. Raw event data were extracted independently, and pooled analyses were performed using log odds ratios (Log OR) with 95% confidence intervals. A random-effects model was applied for meta-analysis. Results Four studies met the inclusion criteria (two cohort, one case-control, and one ongoing RCT), comprising 288 rivaroxaban-treated and 244 VKA-treated patients. Rivaroxaban was associated with numerically fewer recurrent VTE events and lower rates of filter thrombosis, major bleeding, and clinically relevant non-major bleeding, although differences were not statistically significant. No rivaroxaban-related deaths or excess filter complications were reported. Conclusions Rivaroxaban appears to be a safe and effective anticoagulant for patients with IVC filters, showing comparable efficacy to VKAs and a potentially improved bleeding profile. Larger randomized studies are needed to confirm these findings and establish evidence-based anticoagulation strategies for this population.
Summary
Keywords
rivaroxaban, Inferior vena cava filter, Venous Thromboembolism, Deep veinthrombosis, Pulmonary Embolism
Received
14 October 2025
Accepted
09 January 2026
Copyright
© 2026 Wang, Ji, Li, Sun and Qi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Lei Qi
Disclaimer
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