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Direct oral anticoagulant use in hospitalized pediatric patients: Insights from nationwide data
Brandon Buxton1, Katharina Elliott2, Carla Schwalm2
1Bronson Healthcare Group, Portage, Michigan, USA.
Insights
Direct oral anticoagulants (DOACs) are used in pediatric venous thromboembolism (VTE) patients, but less frequently in younger children. DOAC use in children is associated with shorter hospital stays, though heparin initiation remains common.
Area of Science:
- Pediatric Hematology
- Pharmacology
- Clinical Outcomes Research
Background:
- Direct oral anticoagulants (DOACs) have transformed adult venous thromboembolism (VTE) management but were only recently approved for pediatric use in 2021.
- This study analyzes pediatric VTE patients treated with DOACs before and after U.S. Food and Drug Administration (FDA) approval.
Purpose of the Study:
- To characterize pediatric patients receiving DOACs for VTE.
- To evaluate the impact of DOAC use on hospital outcomes in children.
Main Methods:
- Utilized the Epic Cosmos dataset (over 220 million de-identified patients).
- Identified pediatric patients (1-18 years) with a first VTE diagnosis between January 2017 and June 2023.
- Grouped patients by anticoagulation: unfractionated heparin, low molecular weight heparin, and/or DOACs.
Main Results:
- 18.1% of 5138 eligible pediatric VTE patients received DOACs; 81.9% received heparin alone.
- DOAC-treated patients were older (17.4 years) than heparin-only patients (13.0 years).
- DOAC users had shorter overall length of stay and intensive care unit (ICU) admission durations.
Conclusions:
- DOAC utilization in pediatric VTE remains low, particularly in those under 13 years old.
- Transitioning from heparin to DOACs is common (80.6% of DOAC patients received prior heparin).
- Further research is needed on DOAC adherence, VTE recurrence, and costs in children.
Background:
Direct oral anticoagulants (DOACs) have had significant impact on the management of venous thromboembolism (VTE) in adults, but these agents were not approved for use in pediatric patients until 2021. Our objective was to analyze the characteristics of pediatric patients treated with DOACs prior to and following U.S. Food and Drug Administration (FDA) approval for children and evaluate their impact on hospital outcomes.
Procedure:
We utilized the Epic Cosmos dataset (Cosmos), a de-identified dataset of over 220 million patients, to identify patients aged 1-18 years admitted with a first-occurrence diagnosis of VTE between January 1, 2017 and June 30, 2023. Patients were grouped by anticoagulation received (unfractionated heparin, low molecular weight heparin, and/or DOACs).
Results:
Among 5138 eligible patients, 18.1% received DOACs as all or part of their anticoagulation treatment, while 81.9% received heparin therapies alone. Patients treated with DOACs were older than patients treated with heparin monotherapy at 17.4 and 13.0 years, respectively. Non-DOAC patients were more likely to have chronic conditions and were less likely to have pulmonary embolism. Patients treated with DOACs demonstrated shorter overall length of stay and duration of intensive care unit (ICU) admission.
Conclusions:
DOACs remain infrequently utilized in pediatric patients, especially in those under 13 years old. Initiation on heparin therapy and transition to DOACs remains common, with 80.6% of DOAC patients receiving heparin during their hospitalization. While DOAC monotherapy is not currently endorsed as first-line therapy for DVT or PE in children, it is being used clinically. Further research is needed to clarify the impact of DOAC use on patient adherence, VTE recurrence, and healthcare cost.
