Rivaroxaban Treatment in Pediatric Patients With Hematologic Malignancies and Venous Thromboembolism: A Report of Four Cases

Venous thromboembolism is a serious complication in pediatric patients with hematologic malignancies, with acute pulmonary thromboembolism (PTE) posing a significant risk of cardiopulmonary collapse. Since the pediatric approval of rivaroxaban in 2021, marking the introduction of direct oral anticoagulants (DOACs) for this population, we have encountered four cases of thrombosis in children with hematologic malignancies. These included a six-year-old boy with B-cell precursor acute lymphoblastic leukemia treated with heparin followed by rivaroxaban for PTE; a 14-year-old girl with T-lymphoblastic lymphoma (T-LBL) who developed recurrent jugular vein thrombosis and discontinued rivaroxaban due to bleeding; a 10-year-old boy with T-LBL who survived life-threatening PTE with heparin and subsequent rivaroxaban therapy; and a 15-year-old girl with Hodgkin lymphoma who was managed with heparin and rivaroxaban for jugular vein thrombosis. All patients initially received heparin, followed by rivaroxaban for maintenance anticoagulation. Follow-up imaging confirmed thrombus resolution and no recurrence in all cases. Rivaroxaban proved effective in treating venous thrombosis in these pediatric patients, with successful outcomes and an overall favorable safety profile, underscoring the emerging role of DOACs in pediatric thrombosis management.