Pharmacist antithrombotic interventions in critically ill children: A multicenter prospective study

Pharmacists play a crucial role in managing antithrombotic therapy in critically ill adults; however, data on this topic in critically ill children are limited. Therefore, we sought to characterize the types of antithrombotic therapy interventions provided by pediatric pharmacists.

Via a multicenter, prospective, observational study at 9 children's hospitals in the United States, pediatric pharmacists in the pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), mixed intensive care unit (ICU), and pediatric cardiac intensive care unit (PCICU) at participating centers recorded recommendations made during clinical activities during at least 20 shifts. Interventions were documented in a central REDCap database. Descriptive statistics were used to summarize the data. From July 2023 to November 2024, a total of 41 pediatric pharmacists from 9 participating institutions completed data collection on interventions during 697 shifts. A total of 12,632 accepted interventions for 2,264 patients were recorded. Among the 12,632 interventions, 1,130 (9%) were antithrombotic-related interventions, involving 693/2,264 (26.4%) patients. Most antithrombotic medication interventions occurred in the PCICU (844/1,130, 74.7%). Approximately half of the antithrombotic interventions were related to antithrombotic initiation/management (n = 607/1,130, 53.7%), with the majority involving an anticoagulant medication(s) (549/607, 90.4%).

The majority of antithrombotic interventions in critically ill children were in the PCICU and involved anticoagulation for thromboembolism treatment and prevention. Further research is warranted to evaluate pediatric pharmacist-driven clinical services and the impact on antithrombotic outcomes in critically ill children, particularly those with cardiac disease.