Global Survey Reveals Gaps in Pediatric Use of Direct Oral Anticoagulants

Strategic Insights -

Researchers from the University of Toronto conducted a cross-sectional survey to investigate the patterns of use, practice changes, and emerging challenges in the management and prevention of thrombosis in children after the approval of direct oral anticoagulants (DOACs). The survey, which was distributed between January and August 2024, involved pediatric thrombosis treaters from institutions around the world. The findings highlight current gaps in pediatric DOAC use, emphasizing the need for capacity building, advocacy, and further evidence to inform guidelines and policies.

Key Takeaways:

  • The survey involved 100 respondents from 100 different institutions in 53 countries, representing 31% European, 25% North American, 24% Asian, 12% South American, 5% Oceanian, and 3% African countries.
  • 85% of respondents used DOACs, with a higher percentage in high-income countries (89%) compared to low- and middle-income countries (76%).
  • DOACs were more commonly used than low molecular weight heparin (LMWH) or vitamin K antagonists (VKA) in outpatients, but 91% of respondents indicated various barriers to the use of DOACs in children.
  • The survey found that 89% of respondents in high-income countries used DOACs, compared to 76% in low- and middle-income countries (P = .09).
  • The study emphasizes the importance of capacity building, advocacy, and generation of further evidence to inform guidelines and policies.
  • The research was conducted by a team led by Erica Di Ruggiero, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, with contributions from M. Laura Avila, Jennifer Vincelli, and Leonardo R. Brandao.

Statistics:

  • 100 out of 103 respondents completed the survey, representing 100 different institutions from 96 cities in 53 countries.
  • 85% of respondents used DOACs, with a higher percentage in high-income countries (89% vs. 76% in low- and middle-income countries).
  • The survey found that 91% of respondents indicated various barriers to the use of DOACs in children.
  • 89% of respondents in high-income countries used DOACs, compared to 76% in low- and middle-income countries (P = .09).

Sources:

  • A global survey on practice changes and barriers to the use of direct oral anticoagulants in children. Blood Advances, 2025;9(15):3718-3727.
  • NewsRx. University of Toronto Reports Findings in Hematology (A global survey on practice changes and barriers to the use of direct oral anticoagulants in children). Pediatrics Week. August 9, 2025; p 724.