Innovation in Children’s Anticoagulant Drugs

The incidence of venous thromboembolism (VTE) in children has been steadily increasing over the past 20 years, mainly due to increased use of central venous access devices and significant advances in child management under chronic and/or severe medical conditions (1). The rapid growth of VTE in pediatric tertiary care hospitals across the United States has become a problem that cannot be ignored. Pediatricians must deal with the fact that most of the latest treatment recommendations for VTE in children are derived from adult-related research in the treatment of VTE (2). Understanding the reasons for the rapid increase in children with this disease, conducting identification of such children and research on optimal treatment strategies is crucial. Firstly, the coagulation system of the youngest child (< 1 year old) is not yet fully mature, so the level of anticoagulant action is much lower in children of this age group, and these children need to be treated due to differences in pharmacokinetics in drug metabolism. Secondly, children who require anticoagulant therapy often have severe underlying conditions that may exacerbate the risk of severe bleeding or severe adverse drug reactions, making the use of anticoagulants more challenging. Finally, there are relatively few data from prospective clinical trials of anticoagulant therapy in children compared to adults, making anticoagulation decisions more difficult. Standard anticoagulants currently widely used in children include unfractionated heparin, low molecular weight heparin and VKA (Vitamin K Antagonists) (mainly warfarin). These drugs are multi-target drugs because they exert their effects through anticoagulant mechanisms against a variety of coagulation proteins. These drugs have been used in children’s anticoagulant therapy for decades, and despite the lack of prospective studies, they still have the trust of a large number of pediatricians. Due to the relative lack of alternatives, experienced pediatricians can only use these drugs, making them the most commonly used anticoagulants to date. However, looking ahead, the prospects for children’s anticoagulant drugs will change dramatically, conventional drugs will be largely replaced by alternative drugs, and in the future, new oral anticoagulants will be used prospectively on a global scale. Fortunately, three studies on anticoagulants in children were officially released in 2019.