Real-world experience with edoxaban for anticoagulation in children at risk for coronary artery thrombosis.
- Resource Type
- Academic Journal
- Authors
- Sagiv E; Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA.; Newland DM; Department of Pharmacy, Seattle Children's Hospital, Seattle, WA, USA.; Slee A; University College London, London, UK.; Olson AK; Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA.; Seattle Children's Research Institute, University of Washington, Seattle, WA, USA.; Portman MA; Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA.; Seattle Children's Research Institute, University of Washington, Seattle, WA, USA.
- Source
- Publisher: Cambridge University Press Country of Publication: England NLM ID: 9200019 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1467-1107 (Electronic) Linking ISSN: 10479511 NLM ISO Abbreviation: Cardiol Young Subsets: MEDLINE
- Subject
- Language
- English
Background: Direct oral anticoagulants have the potential to improve care in children requiring chronic anticoagulation. Edoxaban has favourable pharmacokinetics that could benefit younger patients but data on long-term safety and efficacy for specific paediatric indications are lacking.
Study Aims: We present a single-centre experience using edoxaban in children who require chronic anticoagulation for large coronary artery aneurysms secondary to Kawasaki disease.
Methods: Weight-based dosing of once-daily oral edoxaban was offered as alternative to standard anticoagulation for patients aged 1-18 years. Chart review was performed for a median follow-up period of 49 months on edoxaban. Steady-state pharmacokinetics and pharmacodynamics of edoxaban were also explored.
Results: Sixteen patients on chronic therapy with edoxaban were included. No major bleeding events were reported. Two patients experienced coronary artery thrombosis after 23 and 38 months on edoxaban, 7 and 11 years after diagnosed with Kawasaki disease, respectively. This predicts 70% event-free rate at 12 years from diagnosis. Area under the curve estimates over the dosing interval of 24 hours were similar to those reported in adults.
Conclusions: Edoxaban use is feasible and well-tolerated for long-term use in paediatric population. We suggest appropriate exposure using weight-based once-daily dosing strategy that may be comparable to standard-of-care anticoagulation in prevention of coronary artery thrombosis. Larger studies are needed to evaluate long-term safety and efficacy of edoxaban in this population.