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Use of Direct Oral Anticoagulants in Children and Adolescents

Manuela Albisetti1

  • 1Division of Hematology and Children's Research Center, University Children's Hospital, Zurich, Switzerland.

Hamostaseologie
|February 13, 2020
PubMed

Insights

Direct oral anticoagulants (DOACs) show promise for pediatric anticoagulation, offering a safer and more effective alternative to traditional treatments like low-molecular-weight heparin (LMWH) and vitamin K antagonists (VKA) in children.

Area of Science:

  • Pediatric Hematology
  • Pharmacology
  • Thrombosis Research

Background:

  • Current pediatric anticoagulation relies on adult-extrapolated regimens for low-molecular-weight heparin (LMWH) and vitamin K antagonists (VKA), which are suboptimal due to unique pediatric hemostatic system characteristics.
  • Existing anticoagulants present significant disadvantages, particularly for newborns and infants, complicating optimal treatment.
  • Direct oral anticoagulants (DOACs) have emerged as effective alternatives in adults, prompting investigation into their pediatric use.

Purpose of the Study:

  • To review available data from terminated and ongoing controlled trials on direct oral anticoagulants (DOACs) in pediatric and adolescent populations.
  • To evaluate the efficacy and safety of DOACs compared to traditional anticoagulants in children.
  • To summarize findings on pediatric-specific formulations and dosing guidelines for DOACs.

Main Methods:

  • Review of terminated and ongoing controlled clinical trials involving direct oral anticoagulants (DOACs) in children and adolescents.
  • Analysis of data from phase III trials assessing DOACs for treatment and prevention of thrombotic events.
  • Evaluation of safety and efficacy profiles of DOACs in pediatric patients with diverse clinical conditions.

Main Results:

  • First results from phase III pediatric trials indicate that DOACs are comparable in efficacy and safety to LMWH and VKA.
  • DOACs demonstrate potential to overcome the limitations of traditional anticoagulants in pediatric patients, including newborns and infants.
  • Ongoing trials are establishing age- and weight-adjusted dosing guidelines and pediatric-specific formulations for DOACs.

Conclusions:

  • Direct oral anticoagulants (DOACs) represent a promising advancement in pediatric anticoagulation, offering improved safety and efficacy.
  • DOACs are poised to become a viable alternative to LMWH and VKA for managing thrombotic events in children.
  • Further research and ongoing trials are crucial for optimizing DOAC therapy in pediatric populations.

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