{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:59:49Z","timestamp":1786121989070,"version":"build-2736575974"},"reference-count":75,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Direct oral anticoagulants (DOACs), including the direct thrombin inhibitor, dabigatran, and factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban), represent a significant advancement in pediatric anticoagulation therapy. Following U.S. FDA approvals for dabigatran and rivaroxaban in 2021 and apixaban in 2025, DOACs are now available for venous thromboembolism (VTE) prevention and treatment in pediatric patients; edoxaban has not yet received pediatric approval. Children with congenital and acquired heart disease (CAHD) constitute a particularly high-risk population for thromboembolic complications due to altered hemodynamics, prosthetic materials, and surgical interventions, necessitating effective anticoagulation strategies. This review summarizes current evidence regarding DOAC use in pediatric CAHD, evaluates safety and efficacy data from recent clinical trials, and highlights key knowledge gaps and future research priorities.<\/jats:p>","DOI":"10.3389\/fcvm.2026.1920897","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:20:22Z","timestamp":1786090822000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The use of direct oral anticoagulants in children with congenital and acquired heart disease"],"prefix":"10.3389","volume":"13","author":[{"given":"Eman","family":"Abdelghani","sequence":"first","affiliation":[{"name":"Department of Pediatric Hematology, Indiana Hemophilia and Thrombosis Center, Innovative Hematology Inc.","place":["Indianapolis, IN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehul","family":"Thakkar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology, Indiana Hemophilia and Thrombosis Center, Innovative Hematology Inc.","place":["Indianapolis, IN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Berthiaume","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology, Indiana Hemophilia and Thrombosis Center, Innovative Hematology Inc.","place":["Indianapolis, IN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology, Indiana Hemophilia and Thrombosis Center, Innovative Hematology Inc.","place":["Indianapolis, IN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"131705","DOI":"10.1016\/j.ijcard.2023.131705","article-title":"Epidemiological study of pediatric rheumatic heart disease: an analysis from the global burden of disease study 2019","volume":"400","author":"Mao","year":"2024","journal-title":"Int J Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e023310","DOI":"10.1161\/JAHA.121.023310","article-title":"Falling through the cracks: the current gap in the health care transition of patients with Kawasaki disease: a scientific statement from the American Heart Association","volume":"10","author":"Dahdah","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e653","DOI":"10.1161\/CIR.0000000000000606","article-title":"Genetic basis for congenital heart disease: revisited: a scientific statement from the American Heart Association","volume":"138","author":"Pierpont","year":"2018","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1016\/j.jacc.2021.03.012","article-title":"Lifespan perspective on congenital heart disease research","volume":"77","author":"Diller","year":"2021","journal-title":"JACC State-of-the-Art Review. 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