When would you recommend using a DOAC in a pediatric patient with VTE?

None of the DOACs are approved as of yet below the age of 18 in the United States. However, results of the phase 3 Einstein Junior study (Rivaroxaban) have been published and the FDA application for approval is pending - the hold up is awaiting results of the Rivaroxaban Fontan surgery study to be a...

Given that DOAC's are not approved for patients under 18 years old, I only use them for patients in their late teenage years such as 16 years and older.

In general:

I would use DOAC when it is approved for the age group.

As for the very young patient, I will only use it when the pediatric formulation is available. For neonates, I stay within the inclusion and exclusion criteria as used in the study as the data in neonates is still limited. I may exp...