Abstract：
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.
METHODS: 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.
METHODS: 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.
摘要：
背景：直接口服抗凝药（DOAC）对成人静脉血栓栓塞（VTE）的管理产生了重大影响，但这些药物直到2021年才被批准用于儿科患者.我们的目的是分析在美国食品药品监督管理局（FDA）批准儿童之前和之后接受DOAC治疗的儿科患者的特征，并评估其对医院预后的影响。
方法：我们使用了EpicCosmos数据集（Cosmos），超过2.2亿患者的数据集，确定在2017年1月1日至2023年6月30日期间首次诊断为VTE的1-18岁患者.患者按接受的抗凝治疗进行分组(普通肝素，低分子量肝素,和/或DOAC)。
结果：在5138名符合条件的患者中，18.1%接受DOAC作为全部或部分抗凝治疗，而81.9%仅接受肝素治疗.接受DOAC治疗的患者在17.4和13.0岁时比接受肝素单药治疗的患者年龄大，分别。非DOAC患者更有可能患有慢性疾病，并且不太可能患有肺栓塞。接受DOAC治疗的患者的总住院时间和重症监护病房（ICU）入院时间较短。
结论：DOAC在儿科患者中很少使用，尤其是13岁以下的人。开始肝素治疗和过渡到DOAC仍然很常见，80.6%的DOAC患者在住院期间接受肝素治疗。虽然DOAC单药治疗目前未被认可为儿童DVT或PE的一线治疗，它正在临床上使用。需要进一步的研究来阐明使用DOAC对患者依从性的影响。VTE复发,和医疗费用。
方法：我们使用了EpicCosmos数据集（Cosmos），超过2.2亿患者的数据集，确定在2017年1月1日至2023年6月30日期间首次诊断为VTE的1-18岁患者.患者按接受的抗凝治疗进行分组(普通肝素，低分子量肝素,和/或DOAC)。
结果：在5138名符合条件的患者中，18.1%接受DOAC作为全部或部分抗凝治疗，而81.9%仅接受肝素治疗.接受DOAC治疗的患者在17.4和13.0岁时比接受肝素单药治疗的患者年龄大，分别。非DOAC患者更有可能患有慢性疾病，并且不太可能患有肺栓塞。接受DOAC治疗的患者的总住院时间和重症监护病房（ICU）入院时间较短。
结论：DOAC在儿科患者中很少使用，尤其是13岁以下的人。开始肝素治疗和过渡到DOAC仍然很常见，80.6%的DOAC患者在住院期间接受肝素治疗。虽然DOAC单药治疗目前未被认可为儿童DVT或PE的一线治疗，它正在临床上使用。需要进一步的研究来阐明使用DOAC对患者依从性的影响。VTE复发,和医疗费用。
