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<p>Venous thromboembolism in children has risen sharply, likely due to improved survival of critically ill patients, increased central line use etc. While LMWH has long been the standard of care, FDA approval of DOACs has introduced an effective and convenient alternative Hence, we conducted a retrospective review of pediatric VTE cases to evaluate usage patterns, limitations, and adverse effects. Retrospective observational study included children (&lt; 18&#xa0;years) with venous thromboembolism treated with rivaroxaban or dabigatran between January 2023 and October 2024. Patients were selected and dosed according to EINSTEIN-Junior and DIVERSITY trial criteria. Clinical, laboratory, and imaging data were reviewed and outcomes including thrombus resolution, treatment modifications, and adverse events were assessed at predefined follow-up intervals. Among 53 children with VTE, 26 (14 rivaroxaban, 12 dabigatran) were analysed. Most patients (69%) were at extremes of age (&lt; 1&#xa0;year or &gt; 10&#xa0;years). The youngest treated was a 5-week-old, 3-kg infant. Seventy-seven percent had at least one risk factor, most commonly a central venous access device. DOAC therapy was effective in 84% of patients, with Budd–Chiari syndrome patients showing stable disease and no recurrence. Among patients with malignancy, DOACs were safely used with thrombus resolution. Four patients who did not respond were resumed on standard of care anticoagulation. No major adverse events were observed. DOACs offer an effective, safe and easy to use option for pediatric venous thrombosis, including in infants and for long-term anticoagulation. However, robust Indian prospective trials comparing DOACs with standard of care are needed.</p>

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Pills Over Pricks: DOAC in Pediatric Thromboses, Real World Data From an Indian Pediatric Hematology Centre, Review of Literature

  • 期刊论文

  • 发表日期：

    2026年7月14日

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  • Sneha Shinde,
  • Ritika Khurana,
  • Purva Kanvinde,
  • Minnie Bodhanwala,
  • Sangeeta Mudaliar

摘要

Venous thromboembolism in children has risen sharply, likely due to improved survival of critically ill patients, increased central line use etc. While LMWH has long been the standard of care, FDA approval of DOACs has introduced an effective and convenient alternative Hence, we conducted a retrospective review of pediatric VTE cases to evaluate usage patterns, limitations, and adverse effects. Retrospective observational study included children (< 18 years) with venous thromboembolism treated with rivaroxaban or dabigatran between January 2023 and October 2024. Patients were selected and dosed according to EINSTEIN-Junior and DIVERSITY trial criteria. Clinical, laboratory, and imaging data were reviewed and outcomes including thrombus resolution, treatment modifications, and adverse events were assessed at predefined follow-up intervals. Among 53 children with VTE, 26 (14 rivaroxaban, 12 dabigatran) were analysed. Most patients (69%) were at extremes of age (< 1 year or > 10 years). The youngest treated was a 5-week-old, 3-kg infant. Seventy-seven percent had at least one risk factor, most commonly a central venous access device. DOAC therapy was effective in 84% of patients, with Budd–Chiari syndrome patients showing stable disease and no recurrence. Among patients with malignancy, DOACs were safely used with thrombus resolution. Four patients who did not respond were resumed on standard of care anticoagulation. No major adverse events were observed. DOACs offer an effective, safe and easy to use option for pediatric venous thrombosis, including in infants and for long-term anticoagulation. However, robust Indian prospective trials comparing DOACs with standard of care are needed.