{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:45:18Z","timestamp":1791477918709,"version":"4.3.4"},"reference-count":94,"publisher":"American Society of Hematology","issue":"5","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>The direct oral anticoagulants (DOACs) rivaroxaban and dabigatran are newly licensed for the treatment and prevention of venous thromboembolism (VTE) in children and mark a renaissance in pediatric anticoagulation management. They provide a convenient option over standard-of-care anticoagulants (heparins, fondaparinux, and vitamin K antagonists) because of their oral route of administration, child-friendly formulations, and significant reduction in monitoring. However, limitations related to therapeutic monitoring when needed and the lack of approved reversal agents for DOACs in children raise some safety concerns. There is accumulating experience of safety and efficacy of DOACs in adults for a broad scope of indications; however, the cumulative experience of using DOACs in pediatrics, specifically for those with coexisting chronic illnesses, is sparse. Consequently, clinicians must often rely on their experience for treating VTE and extrapolate from data in adults while using DOACs in children. In this article, the authors share their experience of managing 4 scenarios that hematologists are likely to encounter in their day-to-day practice. Topics addressed include (1) appropriateness of indication; (2) use for special populations of children; (3)\u00a0considerations for laboratory monitoring; (4) transition between anticoagulants; (5) major drug interactions; (6)\u00a0perioperative management; and (7) anticoagulation reversal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1182\/blood.2022018966","type":"journal-article","created":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T14:13:58Z","timestamp":1688134438000},"page":"389-403","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":24,"title":["How I treat pediatric venous thromboembolism in the DOAC era"],"prefix":"10.1182","volume":"143","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1700-4804","authenticated-orcid":false,"given":"Rukhmi V.","family":"Bhat","sequence":"first","affiliation":[{"name":"1Center for Cancer and Blood Disorders, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6013-1254","authenticated-orcid":false,"given":"Guy","family":"Young","sequence":"additional","affiliation":[{"name":"2Cancer and Blood Disorders Institute, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4574-6175","authenticated-orcid":false,"given":"Anjali A.","family":"Sharathkumar","sequence":"additional","affiliation":[{"name":"3Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"19","key":"2024020116213873500_bib1","doi-asserted-by":"crossref","first-page":"5900","DOI":"10.1021\/jm050101d","article-title":"Discovery of the novel antithrombotic agent 5-chloro-N-({(5S)-2-oxo-3- [4-(3-oxomorpholin-4-yl)phenyl]-1,3-oxazolidin-5-yl}methyl)thiophene- 2-carboxamide (BAY 59-7939): an oral, direct factor Xa inhibitor","volume":"48","author":"Roehrig","year":"2005","journal-title":"J\u00a0Med Chem"},{"issue":"6","key":"2024020116213873500_bib2","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1055\/s-0041-1725944","article-title":"Efficacy and safety of non-vitamin K antagonist oral anticoagulants in pediatric venous thromboembolism treatment and thromboprophylaxis: a systematic review of the literature","volume":"47","author":"Branstetter","year":"2021","journal-title":"Semin Thromb Hemost"},{"issue":"10","key":"2024020116213873500_bib3","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1056\/NEJMra044440","article-title":"Direct thrombin inhibitors","volume":"353","author":"Di Nisio","year":"2005","journal-title":"N\u00a0Engl J Med"},{"issue":"9","key":"2024020116213873500_bib4","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1007\/s00228-013-1510-z","article-title":"Novel oral anticoagulants: clinical pharmacology, indications and practical considerations","volume":"69","author":"Harder","year":"2013","journal-title":"Eur J Clin Pharmacol"},{"issue":"5","key":"2024020116213873500_bib5","first-page":"892","article-title":"Direct inhibitors of coagulation proteins - the end of the heparin and low-molecular-weight heparin era for anticoagulant therapy?","volume":"102","author":"Laux","year":"2009","journal-title":"Thromb Haemost"},{"issue":"8","key":"2024020116213873500_bib6","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.04.004","article-title":"Direct oral anticoagulant agents: pharmacologic profile, indications, coagulation monitoring, and reversal agents","volume":"27","author":"Rose","year":"2018","journal-title":"J\u00a0Stroke Cerebrovasc Dis"},{"issue":"7","key":"2024020116213873500_bib7","first-page":"491","article-title":"Safety of dabigatran etexilate for the secondary prevention of venous thromboembolism in children","volume":"135","author":"Brand\u00e3o","year":"2020","journal-title":"Erratum for Blood"},{"issue":"1","key":"2024020116213873500_bib8","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1055\/s-0039-3400491","article-title":"Use of direct oral anticoagulants in children and adolescents","volume":"40","author":"Albisetti","year":"2020","journal-title":"H\u00e4mostaseologie"},{"issue":"7","key":"2024020116213873500_bib9","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1111\/jth.14813","article-title":"Rivaroxaban for treatment of pediatric venous thromboembolism. 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