Pharmacokinetics of a Microdosed Cocktail Containing Rivaroxaban, Apixaban, and Edoxaban in Children with Congenital Heart Defects

Background: Direct oral anticoagulants (DOACs) are direct inhibitors of coagulation factor Xa and are approved for the use in adults, but not in children. Current anticoagulation regimes in children with congenital heart defects (CHD) consist of phenprocoumon or (low-molecular-weight) heparin. Disadvantages of these regimes comprise invasive monitoring (phenprocoumon) or invasive administration techniques (heparin). The present study examines simultaneously the pharmacokinetics (PK) of the three FXa inhibitors apixaban, edoxaban, and rivaroxaban in children after heart surgery aged 6 months to 6 years.