Extended rivaroxaban prophylaxis following a medical inpatient stay does not provide a net benefit (MARINER)
Clinical Question
Does rivaroxaban for 6 weeks after hospitalization for a medical illness provide more benefit than harm?
Bottom Line
Even in a group of patients chosen for being at higher-than-average risk of venous thromboembolism (VTE), 6 weeks of rivaroxaban prophylaxis following an inpatient stay did not provide a net benefit (LOE = 1b)
Reference
Spyropoulos AC, Ageno W, Albers GW, et al, for the MARINER Investigators. Rivaroxaban for thromboprophylaxis after hospitalization for medical illness. N Engl J Med 2018;379(12):1118-1127. [PMID:30145946]
Study Design
Randomized controlled trial (double-blinded)
Funding
Industry
Allocation
Concealed
Setting
Inpatient (any location) with outpatient follow-up
Synopsis
Although current guidelines do not recommend extended thromboprophylaxis following hospitalization for an acute medical illness, the slightly more favorable risk profile of the newer direct oral anticoagulants, such as rivaroxaban, may have changed that balance in favor of net benefit. These authors identified patients who had recently been hospitalized for heart failure, acute respiratory illness, acute stroke, or acute infectious or inflammatory conditions who received thromboprophylaxis with heparin (unfractionated or low molecular weight) during their hospital stay. Patients at high risk for VTE based on the validated IMPROVE risk score and those at moderate risk with an elevated d-dimer level (N = 12,019) were randomized at discharge to rivaroxaban 10 mg once daily (7.5 mg once daily if creatinine clearance was 30 to 50 mL/min) or matching placebo. All patients were at least 40 years old, had been hospitalized for 3 to 10 days, and if hospitalized for heart failure had an ejection fraction of less than 45%. Patients were contacted several times during the study and asked about signs or symptoms of thromboembolism or bleeding. Outcomes were adjudicated by a committee masked to treatment assignment. Although the authors estimated that they would need 8000 patients to see the 161 events needed for their sample size, they increased the size of the trial and still had only 116 events by the end of the trial. The mean age of included patients was 70 years, 36% were 75 years or older, and 52% were men. Groups were balanced at the start of the study, and analysis was by intention to treat. Overall, there was no net benefit for the rivaroxaban group. There were no significant differences in the primary prespecified outcomes of symptomatic VTE or VTE-related death (hazard ratio [HR] 0.76; 95% CI 0.52 - 1.09), major bleeding (HR 1.88; 0.84 - 4.23), or all-cause mortality. As expected, the trends favored fewer thromboembolic events but more bleeds for the rivaroxaban group.
Extended rivaroxaban prophylaxis following a medical inpatient stay does not provide a net benefit (MARINER)is the Evidence Central Word of the day!
Citation
Barry, Henry, et al., editors. "Extended Rivaroxaban Prophylaxis Following a Medical Inpatient Stay Does Not Provide a Net Benefit (MARINER)." EE+ POEM Archive, John Wiley & Sons, 2025. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/1314629/all/Extended rivaroxaban prophylaxis following a medical inpatient stay does not provide a net benefit (MARINER).
Extended rivaroxaban prophylaxis following a medical inpatient stay does not provide a net benefit (MARINER). In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2025. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/1314629/all/Extended rivaroxaban prophylaxis following a medical inpatient stay does not provide a net benefit (MARINER). Accessed October 19, 2025.
Extended rivaroxaban prophylaxis following a medical inpatient stay does not provide a net benefit (MARINER). (2025). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/1314629/all/Extended rivaroxaban prophylaxis following a medical inpatient stay does not provide a net benefit (MARINER)
Extended Rivaroxaban Prophylaxis Following a Medical Inpatient Stay Does Not Provide a Net Benefit (MARINER) [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2025. [cited 2025 October 19]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/1314629/all/Extended rivaroxaban prophylaxis following a medical inpatient stay does not provide a net benefit (MARINER).
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Extended rivaroxaban prophylaxis following a medical inpatient stay does not provide a net benefit (MARINER)
ID - 1314629
ED - Barry,Henry,
ED - Ebell,Mark H,
ED - Shaughnessy,Allen F,
ED - Slawson,David C,
BT - EE+ POEM Archive
UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/1314629/all/Extended rivaroxaban prophylaxis following a medical inpatient stay does not provide a net benefit (MARINER)
PB - John Wiley & Sons
DB - Evidence Central
DP - Unbound Medicine
ER -