Introduction
Venous thromboembolism (VTE) in children, adolescents, and young adults
(AYAs) typically develops in the setting of multiple thrombotic risk
factors, including central venous access, severe illness/inflammation,
surgery, and/or high estrogen state. While rare in healthy children, VTE
occurs in up to 58 cases per 10,000 pediatric hospital
admissions.1-6 Although the risk factors, associated
medical conditions, and sites of thrombosis vary across children and
AYAs, therapeutic anticoagulant medications (i.e., oral vitamin K
antagonists, subcutaneously injected low molecular weight heparin, newer
direct oral anticoagulants) are prescribed to promote thrombus
resolution while preventing thrombus extension, embolization, or
formation at new sites.7 Anticoagulant adherence is
presumed to be critical for maximizing health outcomes, yet emerging
literature shows that 2-42% of children and AYAs demonstrate
non-adherence or medication-taking that differs from the prescribed
treatment regimen.8-10
To date, pediatric and AYA VTE research has found that younger age and
lower parental education are associated with lower
adherence,8.9 but the modifiable factors, or barriers,
that may lead to non-adherence have not yet been examined. A critical
next step for the field and the primary aim of this project was to begin
to identify barriers to anticoagulation adherence among children and
AYAs. The secondary aim was to explore the relationship between barriers
and adherence. If, as hypothesized, a higher number of barriers is
associated with lower adherence, these data would provide support for
developing adherence-promotion interventions targeting barriers.
Adherence-promotion interventions in children and AYAs prescribed
anticoagulants thus far have targeted general education and the
promotion of self-efficacy, and produced minimal improvements in
adherence rates.11-13 Understanding barriers that
could be targeted to improve anticoagulation adherence, thus, is an
essential step in improving outcomes for children and AYAs prescribed
anticoagulants.