{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:39:52Z","timestamp":1789468792593,"version":"build-2803163510"},"reference-count":56,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hamostaseologie"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1055\/a-2486-6735","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T18:30:31Z","timestamp":1739989831000},"page":"089-101","source":"Crossref","is-referenced-by-count":12,"title":["The Use of DOACs in Pediatrics: Current Therapeutic and Prophylactic Indications, Cardiac Indications, and Real-World Evidence\u2014A Review"],"prefix":"10.1055","volume":"45","author":[{"given":"Alessandra","family":"Bosch","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Children's Hospital Zurich \u2013 Eleonore Foundation, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Olivieri","sequence":"additional","affiliation":[{"name":"Paediatric Thrombosis and Haemostasis Unit, Dr. Von Hauner Children's Hospital, LMU Clinic, LMU Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Holzhauer","sequence":"additional","affiliation":[{"name":"Department of Paediatric Haematology and Oncology, Paediatric Haemostasis Centre, Charit\u00e9 University Medicine, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1542\/peds.2009-0768","article-title":"Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007","volume":"124","author":"L Raffini","year":"2009","journal-title":"Pediatrics"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"e2021054649","DOI":"10.1542\/peds.2021-054649","article-title":"the continued rise of venous thromboembolism across US children's hospitals","volume":"149","author":"S H O'Brien","year":"2022","journal-title":"Pediatrics"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e737S","DOI":"10.1378\/chest.11-2308","article-title":"Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines","volume":"141","author":"P Monagle","year":"2012","journal-title":"Chest"},{"issue":"22","key":"ref4","doi-asserted-by":"crossref","first-page":"3292","DOI":"10.1182\/bloodadvances.2018024786","article-title":"American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism","volume":"2","author":"P Monagle","year":"2018","journal-title":"Blood Adv"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1016\/S2352-3026(19)30219-4","article-title":"Rivaroxaban compared with standard 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Bytzer","year":"2013","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1002\/psp4.12935","article-title":"Evaluation of safety, pharmacokinetics, and pharmacodynamics of apixaban in pediatric subjects at risk of venous or arterial thrombotic disorder","volume":"12","author":"S J Merali","year":"2023","journal-title":"CPT Pharmacometrics Syst Pharmacol"},{"issue":"14","key":"ref27","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1161\/CIRCULATIONAHA.110.006304","article-title":"Risk, clinical features, and outcomes of thrombosis associated with pediatric cardiac surgery","volume":"124","author":"C Manlhiot","year":"2011","journal-title":"Circulation"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s40119-021-00228-4","article-title":"Thrombosis prevention and anticoagulation management in the pediatric patient with congenital heart 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Nephrol"},{"issue":"09","key":"ref50","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.1016\/j.jtha.2024.05.023","article-title":"Anticoagulation for stroke prevention in atrial fibrillation and treatment of venous thromboembolism and portal vein thrombosis in cirrhosis: guidance from the SSC of the ISTH","volume":"22","author":"S Carlin","year":"2024","journal-title":"J Thromb Haemost"},{"issue":"S 01","key":"ref51","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1182\/blood-2021-151005","article-title":"Validating direct oral anticoagulants (DOAC) for use in children by the Throm-PED Doac Registry of the International Pediatric Thrombosis Network","volume":"138","author":"S Holzhauer","year":"2021","journal-title":"Blood"},{"issue":"04","key":"ref52","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1111\/jth.15260","article-title":"International pediatric thrombosis network to advance pediatric thrombosis research: communication from the ISTH SSC 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