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A systematic review of adherence to anticoagulation regimens in pediatric patients

Kevin E Todd1,2, Meghan E McGrady1,3,4, Edith Starbuck5

  • 1Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Pediatric Blood & Cancer
|April 27, 2022
PubMed

Insights

Pediatric anticoagulation nonadherence rates range widely (3-42%) and are linked to patient age and medication interactions. More research is needed on nonadherence impacts in children on blood thinners.

Area of Science:

  • Pediatric Hematology
  • Pharmacology
  • Clinical Medicine

Background:

  • Thromboembolic disease incidence is rising in pediatric populations.
  • Anticoagulation therapy is crucial for treating and preventing these events in children.
  • Limited data exist on anticoagulation nonadherence in pediatric patients compared to adults.

Purpose of the Study:

  • To systematically review the rates, outcomes, and predictors of anticoagulation nonadherence in pediatric patients.
  • To identify knowledge gaps in the current literature regarding pediatric anticoagulation adherence.

Main Methods:

  • A systematic review of scientific literature was conducted.
  • 17 studies meeting inclusion criteria were analyzed from an initial pool of 3581 articles.
  • Studies primarily focused on pediatric patients with cardiac disease using vitamin K antagonists.

Main Results:

  • Reported nonadherence rates varied significantly, from 3% to 42%, depending on study population, adherence definition, and measurement methods.
  • Factors correlating with nonadherence included patient age, target international normalized ratio (INR), and the number of interacting medications.
  • Data linking nonadherence to specific health outcomes in children were scarce, present in only two studies.

Conclusions:

  • Pediatric anticoagulation nonadherence is a significant issue with a wide range of reported rates.
  • Patient-specific factors and medication complexity are associated with nonadherence.
  • Substantial knowledge gaps exist regarding the clinical outcomes of nonadherence in pediatric patients, necessitating further investigation.

Keywords:
anticoagulantcompliancepediatricsystematic review

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