Objective:To retrospectively analyze the clinical efficacy and safety of rivaroxaban alone or in combination with folic acid/methylprednisolone in the treatment of livedoid vasculopathy (LV) .Methods:Clinical data were retrospectively collected from LV patients who were treated with rivaroxaban alone or in combination at the Department of Dermatology, Kaifeng People's Hospital from April 2020 to September 2023. Before treatment, all the patients underwent serum folate and homocysteine tests. Folic acid therapy was given to patients with low folate levels; glucocorticoid therapy was given to patients with generalized skin lesions in the extremities in the acute stage or with dense inflammatory cell infiltration around the dermal vessels on histopathological examination. Clinical symptoms (erythema, ulceration and pain) were scored before and after 8 weeks of treatment. Adverse reactions were recorded during the treatment.Results:A total of 11 patients were collected, including 6 males and 5 females; their ages ranged from 15 to 73 (29.00 ± 17.85) years, and the disease duration ranged from 1 month to 4 years (13.36 ± 15.87 months). Among the 11 patients, 3 were treated with rivaroxaban combined with methylprednisolone and folate, 1 with rivaroxaban combined with methylprednisolone, 5 with rivaroxaban combined with folate, and 2 with rivaroxaban alone. The total score of clinical symptoms was 5.00 ± 2.28 points before treatment, and significantly decreased to 1.18 ± 0.75 points after 8 weeks of treatment with rivaroxaban alone or in combination ( t = 6.90, P = 0.001). In addition, the pain scores of 5 patients who reported pain dropped to 0 point after 8 weeks of treatment. One patient experienced coagulation abnormalities after 2 weeks of treatment, and the coagulation parameters returned to normal without special treatment after 4 weeks. Conclusion:Rivaroxaban alone or in combination with folic acid/methylprednisolone was effective for the treatment of LV with a good safety profile.