{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:02:18Z","timestamp":1788778938455,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T00:00:00Z","timestamp":1719878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>We utilized the Epic Cosmos dataset (Cosmos), a de\u2010identified dataset of over 220 million patients, to identify patients aged 1\u201318\u00a0years admitted with a first\u2010occurrence 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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u00a0years, respectively. Non\u2010DOAC 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>DOACs remain infrequently utilized in pediatric patients, especially in those under 13\u00a0years 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\u2010line 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.31140","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T04:34:25Z","timestamp":1719981265000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Direct oral anticoagulant use in hospitalized pediatric patients: Insights from nationwide data"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9205-7597","authenticated-orcid":false,"given":"Brandon","family":"Buxton","sequence":"first","affiliation":[{"name":"Bronson Healthcare Group  Portage Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Elliott","sequence":"additional","affiliation":[{"name":"Bronson Healthcare Group Western Michigan University Homer Stryker MD School of Medicine  Kalamazoo Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Schwalm","sequence":"additional","affiliation":[{"name":"Bronson Healthcare Group Western Michigan University Homer Stryker MD School of Medicine  Kalamazoo Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018024786"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431\u2010022\u201004487\u20108"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2021.09.021"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2023.04.022"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1590\/1984\u20100462\/;2017;35;4;00008"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009\u20100768"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021\u2010054649"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20104642(21)00343\u20106"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.12788\/jhm.3517"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103026(19)30219\u20104"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103026(20)30368\u20109"},{"key":"e_1_2_9_13_1","unstructured":"U.S. Food and Drug Administration.FDA approves first oral blood thinning medication for children.U.S. Food and Drug Administration; June 21 2021. 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