{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T20:18:20Z","timestamp":1767125900976,"version":"3.48.0"},"reference-count":30,"publisher":"The Pediatric Pharmacy Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Thromboembolism in pediatric patients with congenital heart disease (CHD) is a commonly encountered morbidity. Feeding intolerance is also commonly encountered in patients with CHD and has a direct effect on thromboembolism treatment options, as the site of gastrointestinal absorption for each agent varies. Historically, standard anticoagulation options included unfractionated heparin, enoxaparin, or vitamin K antagonists such as warfarin. Non-vitamin K oral anticoagulants, such as rivaroxaban, have become more widely used in pediatrics since obtaining Food and Drug Administration approval, but are often considered poor options for patients receiving post-pyloric enteral feeds. Adult pharmacokinetic data suggest significant variations in volume of distribution and maximum serum concentrations based on the site of administration within the gastrointestinal tract. We report 3 patients with complex CHD and significant feeding intolerance requiring therapeutic anticoagulation who successfully received rivaroxaban through a post-pyloric feeding tube. When using therapeutic serum concentration monitoring, all 4 serum concentrations were within the reported reference range, and 3 of 4 were within the age-related geometric coefficient of variation. Rivaroxaban appears to have adequate post-pyloric absorption in pediatric patients with CHD based on serum concentration monitoring.<\/jats:p>","DOI":"10.5863\/jppt-24-00123","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T15:57:25Z","timestamp":1765814245000},"page":"807-811","source":"Crossref","is-referenced-by-count":0,"title":["Post-Pyloric Administration of Rivaroxaban With Therapeutic Monitoring in Pediatric Cardiac Patients: Experience in 3 Patients"],"prefix":"10.5863","volume":"30","author":[{"given":"Joshua W.","family":"Branstetter","sequence":"first","affiliation":[{"name":"Department of Pharmacy (JWB, JF, HZ), Children\u2019s Healthcare of Atlanta, Atlanta, GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Woodmansee","sequence":"additional","affiliation":[{"name":"Heart Center (SW), Children\u2019s Healthcare of Atlanta, Atlanta, GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Foland","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (JWB, JF, HZ), Children\u2019s Healthcare of Atlanta, Atlanta, GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hania","family":"Zaki","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (JWB, JF, HZ), Children\u2019s Healthcare of Atlanta, Atlanta, GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia","family":"Townsend","sequence":"additional","affiliation":[{"name":"Children\u2019s Healthcare of Atlanta (NT), Aflac Caner and Blood Disorders Center, Atlanta, GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen L","family":"Zimowski","sequence":"additional","affiliation":[{"name":"Aflac Cancer and Blood Disorders Center (KLM, GW), Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary M.","family":"Woods","sequence":"additional","affiliation":[{"name":"Aflac Cancer and Blood Disorders Center (KLM, GW), Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"issue":"24","key":"JPPT-24-00123-b01","series-title":"Blood","first-page":"2541","article-title":"Improving evidence on anticoagulant therapies for venous thromboembolism in children: key challenges and opportunities","volume":"126","author":"Goldenberg","year":"2015","unstructured":"Goldenberg NA, Takemoto CM, Yee DL, et al. Improving evidence on anticoagulant therapies for venous thromboembolism in children: key challenges and opportunities. Blood. 2015;126(24):2541\u20132547."},{"issue":"7","key":"JPPT-24-00123-b02","series-title":"Thromb Haemostasis","first-page":"464","article-title":"Thromboembolism in newborns, infants and children","volume":"86","author":"Nowak-G\u00f6ttl","year":"2001","unstructured":"Nowak-G\u00f6ttl U, Kosch A, Schlegel N. Thromboembolism in newborns, infants and children. Thromb Haemostasis. 2001;86(7):464\u2013474."},{"issue":"5","key":"JPPT-24-00123-b03","series-title":"Front Pediatr","first-page":"198","article-title":"Pediatric hospital acquired venous thromboembolism","volume":"19","author":"Witmer","year":"2017","unstructured":"Witmer CM, Takemoto CM. Pediatric hospital acquired venous thromboembolism. Front Pediatr. 2017;19(5):198."},{"issue":"10","key":"JPPT-24-00123-b04","series-title":"Cardiol Ther","first-page":"325","article-title":"Thrombosis prevention and anticoagulation management in the pediatric patient with congenital heart disease","volume":"202","author":"Abdelghani","unstructured":"Abdelghani E, Cua CL, Giver J, Rodriguez V. Thrombosis prevention and anticoagulation management in the pediatric patient with congenital heart disease. Cardiol Ther. 202;10:325\u2013348."},{"issue":"12","key":"JPPT-24-00123-b05","series-title":"Cardiol Young","first-page":"2645","article-title":"Frequency, characteristics, antithrombotic therapies, and outcomes of thromboembolism in pediatric patients with CHD undergoing cardiac surgery: a single center retrospective study","volume":"34","author":"Kiskaddon","year":"2024","unstructured":"Kiskaddon AL, Stock AC, Betensky M, et al. Frequency, characteristics, antithrombotic therapies, and outcomes of thromboembolism in pediatric patients with CHD undergoing cardiac surgery: a single center retrospective study. Cardiol Young. 2024;34(12):2645\u20132649."},{"issue":"6","key":"JPPT-24-00123-b06","series-title":"Chest","first-page":"887S","article-title":"Antithrombotic therapy in neonates and children: American College of Chest Physicians evidence-based clinical practice guidelines","volume":"133","author":"Monagle","year":"2008","unstructured":"Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2008;133(6):887S\u2013968S."},{"issue":"1","key":"JPPT-24-00123-b07","series-title":"Lancet Haematol","first-page":"e18","article-title":"Rivaroxaban compared with standard anticoagulants for the treatment of acute venous thromboembolism in children: a randomised, controlled, phase 3 trial","volume":"7","author":"Male","year":"2020","unstructured":"Male C, Lensing AW, Palumbo JS, et al. Rivaroxaban compared with standard anticoagulants for the treatment of acute venous thromboembolism in children: a randomised, controlled, phase 3 trial. Lancet Haematol. 2020;7(1):e18\u2013e27."},{"issue":"6","key":"JPPT-24-00123-b08","series-title":"Semin Thromb Hemost","first-page":"643","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","unstructured":"Branstetter JW, Kiskaddon AL, King MA, et al. 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