Paul Monagle, University of Melbourne
Muayad Azzam, The University of Kansas Health System
Rachel Bercovitz, Northwestern University Feinberg School of Medicine
Marisol Betensky, Johns Hopkins School of Medicine
Rukhmi Bhat, Northwestern University Feinberg School of Medicine
Tina Biss, The Newcastle Upon Tyne Hospitals National Health Service Foundation Trust
Brian Branchford, Versiti Medical Science Institute
Leonardo R. Brandão, University of Toronto
Anthony K.C. Chan, McMaster University
E. Vincent S. Faustino, Yale School of Medicine
Julie Jaffray, University of California - San Diego
Sophie Jones, The University of Melbourne
Hassan Kawtharany, The University of Kansas Health System
Bryce A. Kerlin, The Ohio State University
Nicole Kucine, Weill Cornell Medicine
Riten Kumar, Harvard Medical School
Christoph Male, Medical University of Vienna
Marie-Claude Pelland-Marcotte, Centre Hospitalier Universitaire de Québec
Leslie Raffini, Children's Hospital of Philadelphia
Chittalsinh M. Raulji, University of Nebraska Medical CenterFollow
Sarah E. Sartain, Baylor College of Medicine
Clifford M. Takemoto, St. Jude Children's Research Hospital
Cristina Tarango, University of Cincinnati College of Medicine
C. Heleen van Ommen, Erasmus Medical Center Sophia Children's Hospital
Maria C. Velez, Louisiana State University Health Sciences Center/Children's Hospital New Orleans
Sara K. Vesely, University of Oklahoma Health Sciences Center
John Wiernikowski, McMaster University
Suzan Williams, University of Toronto
Hope P. Wilson, University Of Alabama At Birmingham
Gary Woods, Emory University School of Medicine
Ayesha Zia, University of Texas Southwestern Medical Center
Reem A. Mustafa, The University of Kansas Health System

Document Type

Article

Journal Title

Blood Advances

Publication Date

2025

Volume

9

Abstract

BACKGROUND: The American Society of Hematology (ASH) guidelines on treatment of pediatric venous thromboembolism (VTE) were published in 2018. In the last 6 years, there has been a 10-fold increase in the number of children involved in VTE treatment trials.

OBJECTIVE: The ASH Committee on Quality and Guidelines agreed to update the pediatric guidelines in conjunction with the International Society on Thrombosis and Haemostasis (ISTH). These ASH/ISTH evidence-based guidelines are intended to support patients, clinicians, and other health care professionals in the management of pediatric patients with VTE.

METHODS: ASH/ISTH formed a multidisciplinary guideline panel to minimize potential bias from conflicts of interest. An unconflicted patient representative was not identified. The University of Kansas Health System supported the guideline development process, updating or performing systematic evidence reviews up to 2024. The panel focused specifically on the 2018 questions for which there was the greatest amount of interim data. The panel used the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.

RESULTS: The panel agreed on 20 recommendations and also provided implementation guidance on the optimal use of anticoagulants in pediatric patients. Key recommendations of these guidelines include the role of DOACs in the treatment of a variety of pediatric VTEs.

CONCLUSIONS: Further research is required. Key priorities are understanding the natural history of clinically unsuspected thrombosis across a range of patient subpopulations and obtaining real-world data on the use of DOACs in children.

MeSH Headings

Humans, Venous Thromboembolism, Child, Anticoagulants, Societies, Medical, Hematology, Practice Guidelines as Topic, United States, Hemostasis

ISSN

2473-9537

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