Appendix to the Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions: Pediatric Considerations

Padua, Horacio; Cahill, Anne Marie; Chewning, Rush H.; Himes, Elizabeth A.; Kukreja, Kamlesh; Kumar, Riten; Marshalleck, Francis; Monroe, Eric; Patel, Sheena; Samelson-Jones, Ben; Shaikh, Raja

doi:10.1016/j.jvir.2022.07.006

Cited by 3 publications

(1 citation statement)

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“…For procedures such as lumbar puncture, which are considered high risk of bleeding, it is safer to hold therapeutic anticoagulation for at least 48 hours before and 24 hours after the procedure, provided the patient’s renal and liver functions are normal ( Figure 3 ). 55 , 56 , 57 , 58 If there is bleeding or a need for emergency reversal, readily available, in-house, special coagulation assays could be performed with an intent to assess the presence or absence of drug though they may not correlate with the precise drug level. 40 , 59 Clinicians are advised to check with their special coagulation laboratory regarding access to DOAC monitoring assays ( Table 2 ).…”

Section: Case 3: Cerebral Sinus Venous Thrombosis In a Child With Cancermentioning

confidence: 99%

How I treat pediatric venous thromboembolism in the DOAC era

Bhat

Young²,

Sharathkumar

2024

Blood

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The direct oral anticoagulants (DOACs), rivaroxaban and dabigatran are newly licensed for the treatment and prevention of venous thromboembolism (VTE) in children and mark a renaissance in pediatric anticoagulation management. They provide a convenient option over standard-of-care anticoagulants (heparins, fondaparinux and vitamin K antagonists) due to their oral route of administration, child-friendly formulations, and significant reduction in monitoring. However, limitations related to therapeutic monitoring when needed and the lack of approved reversal agents for DOACs in children raise some safety concerns. There is accumulating experience of safety and efficacy of DOACs in the adults for a broad scope of indications, however the cumulative experience of using DOACs in pediatrics, specifically for those with coexisting chronic illnesses is sparse. Consequently, clinicians must often rely on their experience in treating VTE and extrapolation from adult data while using DOACs in these children. In this edition of "How I treat" the authors' share their experience of managing 4 scenarios that hematologists are likely to encounter in their day-to-day practice. Topics addressed include (1) appropriateness of indication; (2) use in special populations of children; (3) considerations for laboratory monitoring; (4) transition between anticoagulants; (5) major drug interactions; (6) perioperative management; and (7) anticoagulation reversal.

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