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Hamostaseologie 2025; 45(01): 089-101
DOI: 10.1055/a-2486-6735
Review Article

The Use of DOACs in Pediatrics: Current Therapeutic and Prophylactic Indications, Cardiac Indications, and Real-World Evidence—A Review

Alessandra Bosch
1   Department of Haematology, University Children's Hospital Zurich – Eleonore Foundation, Zurich, Switzerland
,
Martin Olivieri
2   Paediatric Thrombosis and Haemostasis Unit, Dr. Von Hauner Children's Hospital, LMU Clinic, LMU Munich, Germany
,
Susanne Holzhauer
3   Department of Paediatric Haematology and Oncology, Paediatric Haemostasis Centre, Charité University Medicine, Berlin, Germany
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Abstract

Based on clinical trials that have been conducted and published in the past decade, direct oral anticoagulants (DOACs) are increasingly being used as an antithrombotic treatment in children with venous thrombotic events and to prevent thrombotic events in children at risk. In this review, current indications and standards for the initiation of DOACs in children are summarized for the treatment of venous thrombotic events and for the primary and secondary prevention in children at risk of developing thromboses based on the published randomized controlled trials (RCT). Similarly, indications for DOACs in children with underlying cardiac disease are portrayed based on RCT findings. Lastly, available real-world data are reviewed for the use of DOACs in pediatric patients with a focus on patients at higher risk of both thrombosis and bleeding who were primarily excluded from the RCTs. DOACs contribute largely to the evolving individualization of care of thrombotic events in children, but at-risk patient populations remain underrepresented regarding DOAC experience, such as preterm infants, and children with severe renal or hepatic disease. Real-world data from observational studies and registries will continue to be necessary to establish DOACs' effectiveness and safety in children in everyday clinical use.

Keywords

DOAC - pediatrics - heart disease - VTE treatment - thromboprophylaxis


Publikationsverlauf

Eingereicht: 06. November 2024

Angenommen: 25. November 2024

Artikel online veröffentlicht:
19. Februar 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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