Patterns of Direct Oral Anticoagulant Use in Pediatric Patients: Results From a Multicenter National Database

BACKGROUND: Direct oral anticoagulants (DOACs) have quickly gained favor due to oral availability, favorable risk profile, and reduced lab monitoring. This study aims to evaluate trends in DOAC use among pediatric patients with new venous thrombotic events (VTE) and factors associated with their selection. PROCEDURE: This was a retrospective study using the Pediatric Health Information System (PHIS) administrative database. We included initial inpatient encounters from 2014 to 2021 for children (age 0-18 years) with an ICD-9 or ICD-10 code for VTE. We compared characteristics of patients who received DOACs to those who did not, through descriptive and statistical analysis and evaluated factors associated with DOAC selection with logistic regression. RESULTS: In 20,332 cases of new VTE, DOACs were administered in 810 encounters (3.98%), most commonly rivaroxaban (75.1% of cases). DOAC use increased over time to 12.0% of encounters in 2021. Patients who received DOACs had greater median age (16 vs. 4 years, p < 0.001), were more commonly female (51.6% vs. 46.7%, p = 0.007), had greater median income ($64,908 vs. $57,165, p < 0.001), and were more likely to carry private insurance (47% vs. 41%, p = 0.003). Patients who received DOACs had lower average hospitalization duration, hospitalization costs, and were less likely to have a complex chronic condition. On regression analysis, factors associated with DOAC use included older age, increased income, and geographic region (p < 0.05). CONCLUSIONS: DOACs are increasingly used in pediatric patients. Decision-making appears to be affected by patient age, medical comorbidities, and income, suggesting prescription trends may not be based on clinical evidence alone.