A global survey on practice changes and barriers to the use of direct oral anticoagulants in children
Bibliographic record
Abstract
ABSTRACT: We aim to describe the patterns of use, practice changes, and emerging challenges after the approval of direct oral anticoagulants (DOACs) for thrombosis management and prevention in children. This cross-sectional survey-based study involved pediatric thrombosis treaters from different institutions around the world. The survey was distributed between January and August 2024. DOAC use and barriers were compared according to the country's income (high-income countries [HICs] vs low- and middle-income countries [LMICs], per World Bank classification). In total, 100 of 103 respondents completed the survey, representing 100 different institutions from 96 cities in 53 countries (31% European, 25% North American, 24% Asian, 12% South American, 5% Oceanian, and 3% African). Eighty-five percent of respondents used DOACs (HICs, 89% vs LMICs, 76%; P = .09). Although DOACs were more commonly used than low molecular weight heparin (LMWH) or vitamin K antagonists (VKA) in outpatients, 91% respondents indicated that <50% of their patients were started on DOACs directly, and 62% reported that <50% of children on long-term LMWH/VKA had been switched to DOACs. Lack of pediatric formulations was the most common barrier (39% in HICs, 52% in LMICs); 9% of respondents in HIC vs 29% in LIMC reported no access to DOACs (P = .009), whereas 21% of respondents in HICs vs 3% in LIMCs stated no barriers to their use (P = .02), indicating inequality. Additional barriers included cost and clinician acceptability and limited knowledge, experience, and expertise. The results highlight current gaps in pediatric DOAC use, emphasizing the importance of capacity building, advocacy, and generation of further evidence to inform guidelines and policies.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".