American Journal of Health-System Pharmacy (AJHP)Pharmacist Antithrombotic Interventions in Critically Ill Children: A Multicenter Prospective Study

⚠️ Small Study / Early Comparative Evidence

Antithrombotic management in critically ill children represents a high-stakes, pharmacist-intensive domain with limited prospective data. This multicenter observational study across 9 US children’s hospitals characterizes the scope of pediatric pharmacist antithrombotic interventions across PICU, NICU, PCICU, and mixed ICU settings, establishing a descriptive foundation for future outcomes research.

Pharmacist Considerations

• PCICU concentration (74.7% of antithrombotic interventions) reflects the anticoagulation burden in pediatric cardiac disease, where circuit patency, valve function, and thromboembolism risk intersect at the dispensing and verification level
• Anticoagulation initiation and management dominated the intervention type (53.7%), with anticoagulants comprising 90.4% of those, signaling that dose individualization, monitoring frequency, and therapeutic range management are the primary pharmacist workload drivers in this population
• Pediatric antithrombotic dosing lacks the robust evidence base available in adults; weight-based calculations, age-dependent pharmacokinetics, and off-label use patterns make pharmacist verification a critical safety checkpoint
• The 9-institution, 41-pharmacist design captures practice variation across center types but uses descriptive statistics only; no outcomes data on thrombotic events, bleeding, or mortality are reported

Practice Applications

• Recognize the PCICU as the highest-density setting for pediatric antithrombotic pharmacist intervention
• Flag anticoagulation initiation orders in critically ill pediatric patients for pharmacist-led review before dispensing
• Integrate weight-based and age-stratified dosing verification into PICU and PCICU anticoagulation workflows
• Monitor for institution-level antithrombotic stewardship