Pharmacokinetic-Driven Individualized Anticoagulation Plan for Pediatric Athletes on Direct Oral Anticoagulants.

Children on anticoagulation have traditionally been discouraged from participating in contact and collision sports due to a perceived bleeding risk. The predictable pharmacokinetics of direct oral anticoagulants permit more individualized management. At Boston Children's Hospital, pharmacokinetic (PK) data were used to develop individualized anticoagulation plans for five athletes on anticoagulation who wished to participate in contact or collision sports. Median (range) duration of follow-up for the cohort was 27 (1-42) months. During this period, two patients sustained four sports-related injuries during anticoagulation interruption, but no clinically significant bleeding or recurrent/progressive thrombosis was observed. All patients safely resumed anticoagulation post-injury.