Between 2010 and 2021, the use of thromboprophylaxis in adolescent patients with sickle cell disease (SCD) admitted to the hospital steadily increased, according to research published in Blood Advances.
Researchers evaluated the use of pharmacologic and nonpharmacologic thromboprophylaxis in adolescent patients with SCD over time using the Pediatric Health Information System (PHIS). They hypothesized that thromboprophylaxis is being increasingly used in hospitalized adolescent patients with SCD.
Between January 1, 2010, and June 30, 2021, a total of 7202 patients aged 13 to 21 years with SCD were admitted to a PHIS hospital (34,094 unique admissions).
The study showed thromboprophylaxis was used in 7.6% of admissions, with 3.6% of admissions receiving pharmacologic prophylaxis and 4.3% receiving mechanical prophylaxis. It also demonstrated use of pharmacologic thromboprophylaxis increased from 1.3% of admissions in 2010 to 14.4% in 2021.
The researchers found that enoxaparin was the most commonly prescribed anticoagulant and was used in 87% of admissions that used pharmacologic thromboprophylaxis. They also noted that the first documented use of prophylactic direct oral anticoagulants (DOACs) was in 2018, and by 2021, DOAC use increased to 25% of admissions with pharmacologic thromboprophylaxis.
“These findings imply that despite the lack of evidence-based data supporting the use of pharmacologic [thromboprophylaxis] in children with SCD, pediatricians are likely to identify patients with SCD at an increased risk for thrombosis and to provide [thromboprophylaxis] in a high-risk setting such as hospital admission,” the study authors explained in their report.
Limitations of the study included the retrospective design, potential errors in coding in administrative databases, lack of granular information regarding the patients’ medical history, and inability of the administrative database to differentiate between therapeutic and prophylactic dosing of anticoagulation.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures.
Davila J, Stanek J, O’Brien SH. Venous thromboembolism prophylaxis in sickle cell disease: a multicenter cohort study of adolescent inpatients. Blood Adv. 2023;7(9):1762-1768. doi:10.1182/bloodadvances.2022007802