Edoxaban for Thromboembolism Prevention in Pediatric Patients With Cardiac Disease

BACKGROUND Standard of care (SOC) anticoagulation for thromboembolism (TE) prevention in children with cardiac disease includes low molecular weight heparins or vitamin K antagonists. Limited data exists for alternate use of direct oral anticoagulants (DOAC) in children. OBJECTIVES The investigators aimed to obtain safety and efficacy data for edoxaban in children. METHODS We performed a phase 3, multinational, prospective, randomized, open-label, blinded-endpoint trial in patients <18 years old with cardiac disease (ENNOBLE-ATE). Patients were randomized 2:1 to age- and weight-based oral edoxaban once-daily versus SOC for 3 months (main study period), stratified by cardiac diagnosis Both groups could continue in an open-label edoxaban extension arm through 1 year. The primary endpoint was adjudicated clinically relevant bleeding (CRB). The main secondary endpoint was symptomatic TE or asymptomatic intracardiac thrombosis. RESULTS The modified intention to treat cohort included 167 children. One patient per group experienced a non-major CRB in the main period. Treatment-emergent adverse events occurred in 46.8% (51/109) with edoxaban and 41.4% (24/58) with SOC. One SOC patient experienced 2 TE events (DVT with PE). Among 147 children in the extension, one CRB event (0.7%) and 4 TEs occurred (2.8%; 2 strokes and 2/33 KD patients with coronary artery thromboses and/or myocardial infarctions). CONCLUSION Edoxaban is a potential alternative mode of thromboprophylaxis in children with cardiac disease showing low rates of CRB and TEs with advantages of once daily dosing and infrequent monitoring requirement.