What is the management of children with exposures to direct oral anticoagulants (DOACs)? What are the expected outcomes among children? Are specific reversal agents (idarucizumab or andexanet alfa) indicated?
A recent systematic review recommends observation and supportive care (which may include oral activated charcoal within the first 2 to 4 h after ingestion). Outcomes are generally benign. Only 1 patient among 93 dabigatran exposures (a 15 y/o with intentional overdose) had minor gum bleeding. Among 61 exposures to apixaban or rivaroxaban, no child had any bleeding despite elevated Anti-Xa activity (when measured). Specific reversal agents are not indicated in the absence of major bleeding.
Maryam Daei, Golnaz Abbasi, Hossein Khalili & Zinat Heidari (2022) Direct oral anticoagulants toxicity in children: an overview and practical guide, Expert Opinion on Drug Safety, DOI: 10.1080/14740338.2022.2110236
Contributed by: Michael Mullins