Key result
Dabigatran plasma concentrations showed similar relationships with coagulation parameters in pediatric patients as in adults, with aPTT rising nonlinearly and dTT/ECT increasing linearly.
Why the study?
To characterize the relationships between total plasma dabigatran concentrations and coagulation laboratory parameters in pediatric patients.
Does dabigatran affect coagulation laboratory parameters in pediatric patients?
Does dabigatran affect coagulation laboratory parameters in pediatric patients?
Dabigatran exhibits consistent concentration-dependent effects on coagulation parameters across pediatric age groups, suggesting developmental hemostatic changes have little effect on drug response.
Models relate dabigatran levels to aPTT, dTT, ECT; leaves open utility for individualized dosing in VTE.
BACKGROUND: Dabigatran etexilate, a direct oral thrombin inhibitor, is approved to treat venous thromboembolism (VTE) in both adults and children. OBJECTIVES: This population analysis characterized relationships between dabigatran total plasma concentrations and coagulation laboratory parameters (activated partial thromboplastin time [aPTT]; diluted thrombin time [dTT]; ecarin clotting time [ECT]). METHODS: = 1,978). Population models were fitted using nonlinear mixed-effects modeling. Covariates (e.g., sex, age) were assessed on baseline and drug-effect parameters, using a stepwise covariate model-building procedure. RESULTS: Overall, relationships between dabigatran, aPTT, dTT, and ECT were similar in children and adults. For children aged <6 months, a higher proportion of baseline samples were outside or close to the upper aPTT and ECT adult ranges. No age-related differences were detected for dTT. With increasing dabigatran concentration, aPTT rose nonlinearly (half the maximum effect at 368 ng/mL dabigatran) while dTT and ECT increased linearly (0.37 and 0.73% change per ng/mL dabigatran, respectively). Mean baseline aPTT (45 vs. 36 seconds) and ECT (40 vs. 36 seconds) were slightly increased for those aged <6 months versus older children. CONCLUSION: The similar relationships of laboratory parameters observed across pediatric age groups suggests that developmental changes in the hemostatic system may have little effect on response to dabigatran.
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Mitchell et al. (2022) studied Venous thromboembolism (VTE) (n=1,978). Dabigatran etexilate vs. Adult reference ranges was evaluated on Relationships between dabigatran total plasma concentrations and coagulation laboratory parameters (aPTT, dTT, ECT). Dabigatran plasma concentrations showed similar relationships with coagulation parameters in pediatric patients as in adults, with aPTT rising nonlinearly and dTT/ECT increasing linearly.
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