Direct Oral Anticoagulants in the Field of Paediatric Thrombosis

Abstract

Direct oral anticoagulants (DOACs) have largely replaced traditional anticoagulants in adults for many years. However, their use in children has only emerged more recently. In this narrative review, we provide an overview on the current knowledge regarding DOACs in paediatric thrombosis.

Rivaroxaban and dabigatran have been shown to be safe and effective options for the treatment of venous thromboembolic events in children. In addition, apixaban, edoxaban and rivaroxaban can be used safely for thromboprophylaxis in children with congenital heart disease who are at high risk for thrombosis. In contrast, the benefits of DOACs in the treatment of arterial thrombosis, stroke, or in the prevention of thromboembolic events in children with leukaemia remain less well established. Owing to their oral administration, predictable pharmacokinetics, fixed dosing, and minimal monitoring requirements, DOACs represent an important advancement in paediatric anticoagulation and offer effective, practical alternatives to traditional therapies. Ongoing research and real-world data will be essential to further define their role across the full spectrum of paediatric thromboembolic disease.