Objective <p>Catheter-related thrombosis (CRT) poses significant risks for gynecologic cancer patients with central venous access devices. This retrospective cohort study evaluated the association between prophylactic rivaroxaban and catheter-related thrombosis in gynecologic oncology outpatients.</p> Methods <p>This single-center study at Fujian Maternity and Child Health Hospital (January 2021–June 2025) included 351 gynecologic oncology patients with peripherally inserted central catheters or implantable venous access ports. Primary exposure was rivaroxaban 10&#xa0;mg daily for ≥ 30 days. Primary outcome was imaging-confirmed catheter-related thrombosis within 180 days. Inverse probability of treatment weighting (IPTW) was used to address confounding.</p> Results <p>Among 351 patients (120 rivaroxaban, 231 controls), CRT occurred in 3 (2.5%) versus 42 (18.2%) patients, respectively (hazard ratio [HR] 0.12, 95% confidence interval [CI] 0.04–0.41; <i>p</i> &lt; 0.001). The IPTW analysis confirmed this association (weighted HR 0.14, 95% CI 0.05–0.44). Major bleeding rates were 1.7% vs. 0.4% (HR 3.86, 95% CI 0.35–42.75; <i>p</i> = 0.273). Clinically relevant non-major bleeding occurred in 6.7% vs. 3.0% (HR 2.23, 95% CI 0.81–6.16; <i>p</i> = 0.121).</p> Conclusion <p>In this retrospective cohort study, prophylactic rivaroxaban was associated with lower catheter-related thrombosis incidence in gynecologic cancer patients. These observational findings warrant prospective randomized validation.</p> Clinical trial number <p>Not applicable.</p>