Current practices of index hospitalization anticoagulant utilization in pediatric patients with acute myeloid leukemia (AML)

Management and prevention of thromboembolism (TE) in pediatric acute myeloid leukemia (AML) are challenging due to prolonged periods of thrombocytopenia and associated bleeding. There are no guidelines for prophylactic or therapeutic anticoagulation for children with AML. This study aimed to understand anticoagulation utilization and its association with bleeding events during index hospitalization in children with AML, both with and without thromboses. A retrospective cohort study was performed using the Pediatric Health Information System (PHIS) administrative database of index hospitalizations for patients aged 1-21 years from 2016-2024 with the diagnosis of AML across 49 children’s hospitals. Demographic data, diagnosis of TE, anticoagulation use, and bleeding events (BE) were extracted. A total of 3,768 patients with AML were included with 167 (4.4%) experiencing a TE. A total of 171 patients (4.5%) received anticoagulation with almost half receiving anticoagulation in the absence of TE diagnosis (presumed prophylaxis). Of patients with a TE, 88 (52.3%) received anticoagulation, with the remainder receiving no anticoagulation. Enoxaparin was the most frequently utilized anticoagulant followed by rivaroxaban, but wide institutional variation was observed in choice of anticoagulant. A total of 750 patients (20%) experienced at least one BE. Most patients (705/750; 94%) with BE received no anticoagulation. Prospective research is needed to determine the most safe and effective use for prophylactic and therapeutic anticoagulation in this patient population.