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Anticoagulation of pediatric patients with venous thromboembolism in 2023
C Heleen van Ommen1, Saskia E Luijnenburg1
1Department of Pediatric Hematology, Sophia Children's Hospital, Erasmus MC, Rotterdam, the Netherlands.
Insights
Pediatric venous thromboembolism (VTE) management is complex. New oral anticoagulants offer advantages, but more real-world data is needed for neonates and infants.
Area of Science:
- Pediatric Hematology
- Vascular Medicine
- Pharmacology
Background:
- Venous thromboembolism (VTE) presents unique challenges in pediatric patients.
- Management is complicated by age-specific factors including epidemiology, bleeding risk, and drug pharmacokinetics.
Purpose of the Study:
- To evaluate the role and suitability of newer oral anticoagulants in pediatric VTE management.
- To highlight the need for further real-world data in specific pediatric populations.
Main Methods:
- Review of recent clinical studies and guidelines on pediatric VTE treatment.
- Analysis of the properties of oral factor IIa and Xa inhibitors in children.
Main Results:
- New oral anticoagulants are authorized for pediatric VTE treatment and prevention.
- These agents offer benefits like oral administration and no need for monitoring.
- Limited inclusion of neonates and infants in pivotal trials necessitates further investigation.
Conclusions:
- Oral anticoagulants represent a promising advancement in pediatric VTE care.
- Real-world data is crucial for establishing evidence-based recommendations, especially for neonates and infants.
Abstract:
Venous thromboembolism (VTE) is a rare and heterozygous disease in children. Management of VTE in children is complicated by age-related differences in epidemiology, recurrent VTE and bleeding risk, hemostatic proteins and pharmacokinetics of anticoagulants. Recently, the choice of anticoagulation has expanded to oral factor IIa and Xa inhibitors, which have been authorized for children for treatment of acute VTE and extended secondary prevention. These drugs have several properties that make them extremely suitable for use in children, including oral administration, antithrombin independence, less interactions with food and drugs and no need for monitoring. Unfortunately, the phase 3 studies had many exclusion criteria, and only a few term neonates and infants were included in these studies. Additional real-world data is needed to make evidence-based recommendations in these age and patient groups, as well.
