PB0468 - Direct Oral Anticoagulant Therapy in Adolescent Venous Thromboembolism: A Systematic Review

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Shaikha Alqahtani, MD

Pediatric Hematology Oncology Fellow
University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States
HOUSTON, Texas, United States

Co-Author(s)

KG

Karen Gibbs

Scientific Research Project Manager
University of Texas Health Science Center Cizik School of Nursing, Houston, TX
Houston, Texas, United States
Natalie A. Montanez, FNP-C, CACP

Nurse Practitioner, Certified Anticoagulation Care Provider
University of Texas Health Science Center of Houston, McGovern Medical School, Gulf States Hemophilia and Thrombophilia Center, Houston, Texas
Houston, Texas, United States
KK

Kate Krause

Medical Research Librarian
Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX
Houston, Texas, United States
C. Heleen Van Ommen, MD, PhD (she/her/hers)

Head dept. Pediatric Hematology & Oncology
Erasmus MC Sophia Children's Hospital
Rotterdam, Zuid-Holland, Netherlands
LS

Lakshmi Srivaths

Professor of Pediatrics, Division of Hematology
University of Texas Health Science Center of Houston, McGovern Medical School, Gulf States Hemophilia and Thrombophilia Center
Houston, Texas, United States

Background: Adolescent venous thromboembolism (VTE) is characterized by unique risk factors, therapy, and complications when compared to younger children, with rising incidence. The recent approval in countries of direct oral anticoagulants (DOACs) in pediatric VTE has led to increased use in adolescents.

Aims: We undertook a systematic review to analyze the available evidence regarding safety and efficacy of DOAC therapy in adolescent VTE.

Methods: The protocol was registered in PROSPERO 2022 (CRD42022363928). A systematic search was performed in Ovid MEDLINE, Ovid EMBASE, Cochrane Central, and the Web of Science, with inclusion criteria: age 10-18 years, VTE diagnosis, DOAC therapy, and exclusion criteria: VTE prophylaxis, non-DOAC anticoagulant therapy, arterial thrombosis, age < 10 or >18 years. Randomized control trials, cohort, prospective, retrospective, and other relevant study types were included. Case reports and series (N < 3), guidelines, protocols, and reviews were excluded. Titles/abstracts and full-text articles were screened by two independent investigators. Disagreements were resolved by consensus. Endpoints included thrombus resolution, VTE recurrence, and major bleeding.

Results: Nine reports of 5 studies on DOAC therapy in adolescent VTE were identified (Fig.1), details given in Table 1. 367 adolescents, with 209 (56.9%) females, (two studies did not specify gender), age range 10.5-17.3 years, were treated with DOACs, Rivaroxaban (N=247; 67.3%) and Dabigatran (N=120; 32.6%). VTE outcome reported (N=317) showed 78.2% (N=248) complete/partial resolution (CR/PR), 5.3% (N=17) stable, 1.2% (N=4) worse, 9.7% (N=31) uncertain, 3.5% (N=13) VTE recurrence, and 0.8% (N=3) major bleeding.

Conclusion(s): Our systematic review of DOAC therapy in adolescent VTE showed CR/PR in two-thirds of the patients analyzed, with low incidence of VTE recurrence and major bleeding. Based on our results, DOAC therapy appears safe and effective for adolescent VTE. Future prospective studies in an exclusive adolescent population are required to validate our results.