OBJECTIVES The American College of Chest Physicians Guideline recommends anticoagulant therapy for at least three months in children with venous thromboembolism. The objectives of the study were to evaluate the medication utilization patterns, and the predictors of adherence to anticoagulant therapy in the pediatric population. METHODS Texas Medicaid medical and prescription claims from June 01, 2007 to September 31, 2012 were extracted for children (<18 years) hospitalized for Pulmonary Embolism (PE) or Deep Vein Thrombosis (DVT). The index date was defined as the date of the first prescription of an anticoagulant warfarin (oral) and/or enoxaparin (injectable) given within 14 days after discharge from hospitalization. Patients hospitalized for atrial fibrillation, air/fat embolism, bleeding/coagulation disorder within 90 days of discharge were excluded. Proportion of days covered (PDC≥80% vs. <80%) was used to assess adherence to anticoagulants while controlling for demographics, cause of hospitalization, history of NSAID use, anticoagulant use, malignancy, drug type, and Charlson comorbidity index (CCI). A multivariate logistic regression analysis was used. RESULTS The patients (n=57) had a mean (±SD) age of 14.1 (±4.9) years, were primarily female (54.4%), African American (61.4%), enoxaparin users (54.4%), and had a mean (±SD) CCI of 19.7 (±39.4). The mean (±SD) adherence rates for warfarin and enoxaparin were 85.6% (±22.3%) and 78.2% (±22.7%), respectively. 66.7% were adherent (PDC≥80%) to anticoagulant therapy. The median (Mean±SD) persistence with anticoagulant therapy was 84.6 (71.9±33.3) days. Logistic regression showed that increasing age was significantly associated with adherence to anticoagulant therapy (Odds Ratio=1.3, p=0.0158), after controlling for covariates. CONCLUSIONS Nearly one third of the pediatric patients on anticoagulant therapy after discharge from hospitalization with PE or DVT were non-adherent. Further research is needed to underline the factors responsible for non-adherence in pediatric patients.