Anticoagulant Therapy for 6 Weeks vs 3 Months and Recurrence and Bleeding in Patients Younger Than 21 Years With Provoked Venous Thromboembolism—Reply

Abstract

Development and validation of the 4AT: a new rapid screening tool for delirium. Accessed February 18, 2022. https://www.journalslibrary.nihr.ac.uk/ programmes/hta/1114301/#/ 6. Goodman SN, Berlin JA. The use of predicted confidence intervals when planning experiments and the misuse of power when interpreting results.

Direct oral anticoagulants in pediatric venous thromboembolism: Review of approved products rivaroxaban and dabigatran

“…With the introduction of DOACs, the oral route of administration without the need for therapeutic monitoring is a triumph for patients and their healthcare teams alike. This data, along with newer studies such as the Kids-DOTT trial (showing the non-inferiority of 6 weeks vs. 3 months of AC in pediatric patients with provoked VTE) ( 47 ), is heralding an optimistic era in treating pediatric VTE.…”

50 Years of Pediatric Hemostasis: Knowledge, Diagnosis, and Treatment

“…53 As most cases of VTE in children are triggered by transient and removable risk factors, it has recently been suggested that shorter courses of anticoagulant treatment may be sufficient for selected patients. 54…”

“…53 As most cases of VTE in children are triggered by transient and removable risk factors, it has recently been suggested that shorter courses of anticoagulant treatment may be sufficient for selected patients. 54 Infants with severe genetic thrombophilia, such as homozygous PC deficiency, present within hours following delivery with purpura fulminans due to thrombosis within the postcapillary venules of the skin. This devastating disease and its treatment, using fresh frozen plasma and anticoagulants, were reported in the late 1980s.…”

Duration of Anticoagulant Treatment for Acute Provoked Venous Thromboembolism in Pediatric Patients

“…In this issue of JAMA , Goldenberg et al report findings from a noninferiority randomized clinical trial (RCT) that compared the efficacy and safety of shorter vs longer anticoagulant therapy to prevent recurrent venous thromboembolism without causing more clinically relevant bleeding events in patients younger than 21 years of age who experienced an acute provoked venous thromboembolism. A venous thromboembolism was considered provoked if it could be attributed to a hospitalization-related event, trauma, or a central venous catheter.…”

“…Given that the study was conducted at 42 centers in 5 countries over 13 years, it is unlikely to be repeated. Although the data reported by Goldenberg et al are compelling enough that some practitioners may want to apply them immediately, the results should be applied judiciously and not be extrapolated to patients with unprovoked venous thromboembolism and older patients.…”