“…Although idarucizumab and andexanet-α are approved by the US Food and Drugs Administration for adults for reversal of dabigatran and rivaroxaban/apixaban, respectively, it is neither approved nor tested for children. 65 , 66 , 67 There are only 2 published case reports of using idarucizumab and andexanet-α for children, for overdose and bleeding reversal. 68 , 69 Interestingly, a recent survey of pediatric hematologists assessing preferences for reversal of bleeding associated with DOACs reported prothrombin complex concentrates as the preferred option.…”
Section: Case 3: Cerebral Sinus Venous Thrombosis In a Child With Cancermentioning
The direct oral anticoagulants (DOACs), rivaroxaban and dabigatran are newly licensed for the treatment and prevention of venous thromboembolism (VTE) in children and mark a renaissance in pediatric anticoagulation management. They provide a convenient option over standard-of-care anticoagulants (heparins, fondaparinux and vitamin K antagonists) due to their oral route of administration, child-friendly formulations, and significant reduction in monitoring. However, limitations related to therapeutic monitoring when needed and the lack of approved reversal agents for DOACs in children raise some safety concerns. There is accumulating experience of safety and efficacy of DOACs in the adults for a broad scope of indications, however the cumulative experience of using DOACs in pediatrics, specifically for those with coexisting chronic illnesses is sparse. Consequently, clinicians must often rely on their experience in treating VTE and extrapolation from adult data while using DOACs in these children. In this edition of "How I treat" the authors' share their experience of managing 4 scenarios that hematologists are likely to encounter in their day-to-day practice. Topics addressed include (1) appropriateness of indication; (2) use in special populations of children; (3) considerations for laboratory monitoring; (4) transition between anticoagulants; (5) major drug interactions; (6) perioperative management; and (7) anticoagulation reversal.
“…Although idarucizumab and andexanet-α are approved by the US Food and Drugs Administration for adults for reversal of dabigatran and rivaroxaban/apixaban, respectively, it is neither approved nor tested for children. 65 , 66 , 67 There are only 2 published case reports of using idarucizumab and andexanet-α for children, for overdose and bleeding reversal. 68 , 69 Interestingly, a recent survey of pediatric hematologists assessing preferences for reversal of bleeding associated with DOACs reported prothrombin complex concentrates as the preferred option.…”
Section: Case 3: Cerebral Sinus Venous Thrombosis In a Child With Cancermentioning
The direct oral anticoagulants (DOACs), rivaroxaban and dabigatran are newly licensed for the treatment and prevention of venous thromboembolism (VTE) in children and mark a renaissance in pediatric anticoagulation management. They provide a convenient option over standard-of-care anticoagulants (heparins, fondaparinux and vitamin K antagonists) due to their oral route of administration, child-friendly formulations, and significant reduction in monitoring. However, limitations related to therapeutic monitoring when needed and the lack of approved reversal agents for DOACs in children raise some safety concerns. There is accumulating experience of safety and efficacy of DOACs in the adults for a broad scope of indications, however the cumulative experience of using DOACs in pediatrics, specifically for those with coexisting chronic illnesses is sparse. Consequently, clinicians must often rely on their experience in treating VTE and extrapolation from adult data while using DOACs in these children. In this edition of "How I treat" the authors' share their experience of managing 4 scenarios that hematologists are likely to encounter in their day-to-day practice. Topics addressed include (1) appropriateness of indication; (2) use in special populations of children; (3) considerations for laboratory monitoring; (4) transition between anticoagulants; (5) major drug interactions; (6) perioperative management; and (7) anticoagulation reversal.
“…Options to attempt to achieve hemostasis include the specific reversal agent andexanet alfa, prothrombin complex concentrate, or activated prothrombin complex concentrate. Andexanet alfa is not readily available in many centers, and there are no published data on dosing, safety, or efficacy in children [ 8 ].…”
mentioning
confidence: 99%
“…The following ( Figure ) is a proposed plan for management of apixaban overdose in children, based on available evidence [ 6 , 7 , 8 ] and expert opinion of the authors: Figure Apixaban overdose management algorithm …”
Patients with diffuse glioma are at high risk of developing venous thromboembolism (VTE) over the course of the disease, with up to 30% incidence in patients with glioblastoma (GBM) and a lower but nonnegligible risk in lower-grade gliomas. Recent and ongoing efforts to identify clinical and laboratory biomarkers of patients at increased risk offer promise, but to date, there is no proven role for prophylaxis outside of the perioperative period. Emerging data suggest a higher risk of VTE in patients with isocitrate dehydrogenase (IDH) wild-type glioma and the potential mechanistic role of IDH mutation in the suppression of production of the procoagulants tissue factor and podoplanin. According to published guidelines, therapeutic anticoagulation with low molecular weight heparin (LMWH) or alternatively, direct oral anticoagulants (DOACs) in patients without increased risk of gastrointestinal or genitourinary bleeding is recommended for VTE treatment. Due to the elevated risk of intracranial hemorrhage (ICH) in GBM, anticoagulation treatment remains challenging and at times fraught. There are conflicting data on the risk of ICH with LMWH in patients with glioma; small retrospective studies suggest DOACs may convey lower ICH risk than LMWH. Investigational anticoagulants that prevent thrombosis without impairing hemostasis, such as factor XI inhibitors, may carry a better therapeutic index and are expected to enter clinical trials for cancer-associated thrombosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
