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Post-Pyloric Administration of Rivaroxaban With Therapeutic Monitoring in Pediatric Cardiac Patients: Experience in 3

Joshua W Branstetter1, Sarah Woodmansee2, Jordan Foland1

  • 1Department of Pharmacy (JWB, JF, HZ), Children's Healthcare of Atlanta, Atlanta, GA.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|December 19, 2025
PubMed

Insights

Rivaroxaban can be safely administered via post-pyloric feeding tubes in pediatric patients with congenital heart disease (CHD) and feeding intolerance. Therapeutic drug monitoring confirmed adequate absorption and consistent serum concentrations, supporting its use in this challenging population.

Area of Science:

  • Pediatric Cardiology
  • Pharmacology
  • Thrombosis Management

Background:

  • Thromboembolism is a significant complication in pediatric patients with congenital heart disease (CHD).
  • Feeding intolerance in CHD patients complicates anticoagulation choices due to variable gastrointestinal absorption.
  • Traditional anticoagulants include heparin, enoxaparin, and warfarin.

Purpose of the Study:

  • To evaluate the efficacy and safety of rivaroxaban in pediatric patients with complex CHD and feeding intolerance requiring therapeutic anticoagulation.
  • To assess rivaroxaban absorption and serum concentrations when administered via post-pyloric feeding tubes.

Main Methods:

  • Case series reporting on 3 pediatric patients with complex CHD and feeding intolerance.
  • Administration of rivaroxaban via post-pyloric feeding tubes.
  • Therapeutic serum concentration monitoring of rivaroxaban.

Main Results:

  • All reported rivaroxaban serum concentrations were within the therapeutic reference range.
  • Three out of four measured concentrations fell within the age-related geometric coefficient of variation.
  • Successful therapeutic anticoagulation was achieved in all patients.

Conclusions:

  • Rivaroxaban demonstrates adequate post-pyloric absorption in pediatric patients with CHD and feeding intolerance.
  • Serum concentration monitoring supports the safe and effective use of post-pyloric rivaroxaban in this population.
  • This approach offers a viable anticoagulation option for CHD patients with complex feeding challenges.

Keywords:
congenital heart diseasedirect oral anticoagulantrivaroxabanthromboembolismtranspyloric feeding

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