Revisiting the anticoagulation therapy: when warfarin is preferable. Novel clinical approach to use direct oral anticoagulants in children

Authors: Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Editorial article


DOI: https://doi.org/10.24022/1997-3187-2022-16-1-7-14

For citation: Golukhova E.Z. Revisiting the anticoagulation therapy: when warfarin is preferable. Novel clinical approach to use direct oral anticoagulants in children. Creative Cardiology. 2022; 16 (1): 7–14 (in Russ.). DOI: 10.24022/1997-3187-2022-16-1-7-14

Received / Accepted:  20.03.2022 / 22.03.2022

Keywords: thrombosis thromboembolic events mechanical and bioprosthetic heart valves warfarin vitamin K antagonists oral anticoagulants antiphospholipid syndrome left ventricular thrombosis anticoagulation in pediatric patients anticoagulation after Fontan operation

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Abstract

Clinical spectrum of prothrombotic events is rather wide. It is common knowledge that traditional indications for oral anticoagulants include the most common scenarios in patients with atrial fibrillation and recurrent venous thromboembolism (VTE), but mechanical valve prosthesis as well as antiphospholipid syndrome still require vitamin K antagonists. Current guidelines are limited and recommend for young patients with or at risk for developing blood clots be treated with standard anticoagulation therapy – warfarin or heparin. In December 2021 FDA approved two new indications for rivaroxaban to prevent and treat blood clots in pediatric patients. After EINSTEIB-Jr, the largest study for pediatric pts from birth to 18 yo with previously diagnosed VTE and UNIVERSE, the first clinical trial examined a direct oral anticoagulants (DOAC) for thromboembolic events prevention in pediatric pts after Fontan, – rivaroxabane was approved by FDA in those pts. The present article covers all these troubling questions.

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About Authors

Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of RAS, Director; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery