The use of direct oral anticoagulants in children with congenital and acquired heart disease

Figures

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  Figure 1. The coagulation cascade, anticoagulant targets, laboratory monitoring assays, and associated challenges in pediatric heart disease. Vitamin K antagonists (VKAs) inhibit synthesis of factors II, VII, IX, and X; heparin- based anticoagulation include unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) which both potentiate antithrombin-mediated inhibition of thrombin and factor Xa; and direct oral anticoagulants (DOACs) directly inhibit either thrombin (dabigatran) or factor Xa (apixaban, edoxaban, rivaroxaban). Key monitoring assays and pediatric-specific are outlined for each drug class. PT, prothrombin time; INR, International Normalized Ratio; POC, point-of-care, aPTT, activated partial thromboplastin time; ACT, activated clotting time; HIT, heparin induced thrombocytopenia.

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  Figure 2. Strategic roadmap for DOAC research in pediatric CAHD: from knowledge gaps to research opportunities. This figure illustrates the identified evidence gaps to prioritized research objectives for DOACs in children.