Direct Oral Anticoagulants – Are They Ready for Primetime in the Pediatric Population?

A 13-year-old girl (110 kg) with a history of asthma, depression, and attention deficit disorder presents to the emergency department with a swollen right leg which was warm and painful to the touch. The pain is unrelieved by acetaminophen and ibuprofen that she took prior to getting medical attention. She was recently on a trip to Australia and came back a few days ago. Her home medications include oral contraceptive, albuterol inhaler as needed, fluoxetine, and lisdexamfetamine. Physical exam was notable for a tender right calf with mild edema of the ankle. The exam was otherwise unremarkable. The only significant laboratory finding is an elevated D-dimer of 3 mcg/mL. A bilateral venous duplex is obtained and shows that the right lower extremity is positive for deep and superficial vein thrombosis involving the right popliteal and posterior tibial veins. Subcutaneous enoxaparin 1 mg/kg/dose every 12 hours is started for the deep vein thrombosis and the medical team is trying to decide on a long-term oral anticoagulant for this patient.

Based on the current literature, which one of the following oral anticoagulants is most appropriate upon discharge of this patient?

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