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Direct oral anticoagulants versus standard anticoagulation in children treated for acute venous thromboembolism

Jie Chen1,2, Guoshan Bi1,2, Fei Wu3

  • 1Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530000, Guangxi, China.

Pediatric Research
|September 7, 2022
PubMed

Insights

Direct oral anticoagulants (DOACs) show promise in treating pediatric venous thromboembolism (PVTE), reducing recurrent VTE without increasing mortality or major bleeding. However, nonmajor bleeding events were more frequent with DOACs in this population.

Area of Science:

  • Pediatric Hematology
  • Pharmacology
  • Clinical Trials

Background:

  • Direct oral anticoagulants (DOACs) are standard for adult venous thromboembolism (VTE) but understudied in pediatric VTE (PVTE).
  • Existing research on PVTE primarily focuses on epidemiology and traditional anticoagulants, with limited data on novel oral anticoagulants.

Approach:

  • A systematic meta-analysis of randomized controlled trials (RCTs) was conducted, searching multiple databases until 2021.
  • Seven RCTs involving 1139 pediatric patients with VTE were analyzed using the Mantel-Haenszel method and random-effects model.

Key Points:

  • DOACs significantly reduced recurrent VTE (RR 0.42) compared to standard anticoagulation in pediatric patients.
  • No significant differences were observed in mortality (RR 0.50) or major bleeding (RR 0.46) between DOACs and standard treatments.
  • A higher incidence of clinically relevant nonmajor bleeding was noted with DOACs (RR 2.71), particularly with rivaroxaban.

Conclusions:

  • DOACs represent a viable alternative to standard anticoagulation for treating pediatric VTE, offering comparable safety profiles regarding major adverse events.
  • Dabigatran and rivaroxaban demonstrated similar efficacy, though rivaroxaban was associated with a higher rate of nonmajor bleeding.

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