Safety and clinical outcomes of antithrombotic therapy in children and young adults with kidney failure on dialysis: a 10-year single-center retrospective cohort study

BACKGROUND: Pediatric and young adult patients with kidney failure on dialysis are at increased risk of developing thrombotic events (TE). Antithrombotic therapy in this population is challenging due to a concomitant elevated risk of bleeding and the lack of pediatric and young adult-specific data. METHODS: We conducted a 10-year single-center retrospective cohort study of patients < 23 years of age with kidney failure on dialysis to describe antithrombotic therapy use and evaluate associated safety and clinical outcomes. RESULTS: Among 77 patients with kidney failure on dialysis, 33 (42.9%) received antithrombotic therapy. Common treatment indications included acute TE, secondary thromboprophylaxis due to prior thrombosis, and primary thromboprophylaxis in the setting of an identified prothrombotic laboratory abnormality. Low molecular weight heparins (LMWHs) were the most used agents, followed by aspirin and direct oral anticoagulants (DOACs). Bleeding complications occurred in 3 patients (9.1%), including 2 clinically relevant non-major events and 1 minor event. No use of reversal agents or transfusion was required. Recurrent TE were reported in 5 patients (15.2%). Four of them had documented non-adherence, and one occurred after discontinuation of antithrombotic therapy. CONCLUSIONS: Antithrombotic therapy in pediatric and young adult patients with kidney failure on dialysis appears to be safe and may be associated with relatively low thrombotic recurrence rates, particularly when adherence is maintained and therapy is closely monitored. This observation is especially relevant given the limited age-specific evidence and the absence of standardized guidance for antithrombotic management in this population.