ASH/ISTH 2026 Guidelines for Anticoagulant Prophylaxis in Pediatric Patients at Risk of Venous Thromboembolism

Authors

• Marisol Betensky, Johns Hopkins School of Medicine
• Muayad Azzam, University of Kansas Medical Center
• Rachel Bercovitz, Ann & Robert H. Lurie Children's Hospital of Chicago
• Rukhmi V. Bhat, Ann & Robert H. Lurie Children's Hospital of Chicago
• Tina Biss, The Newcastle upon Tyne Hospitals NHS Foundation Trust
• Brian Branchford, Medical College of Wisconsin
• Leonardo R. Brandão, The Hospital for Sick Children
• Anthony K.C. Chan, McMaster University
• E. Vincent S. Faustino, Yale School of Medicine
• Qais Hamarsha, University of Kansas Medical Center
• Julie Jaffray, Rady Children's Hospital-San Diego
• Sophie Jones, University of Melbourne
• Hassan Kawtharany, University of Kansas Medical Center
• Bryce A. Kerlin, The Ohio State University College of Medicine
• Jana Khawandi, University of Kansas Medical Center
• Grace Krider, Ascension St. Vincent Indianapolis
• Nicole Kucine, Weill Cornell Medicine
• Riten Kumar, Harvard Medical School
• Christoph Male, Medical University of Vienna
• Paul Monagle, University of Melbourne
• Marie-Claude Pelland-Marcotte, Centre Mère-Enfant
• Leslie Raffini, Children's Hospital of Philadelphia
• Chittalsinh M. Raulji, University of Nebraska Medical CenterFollow
• Sarah E. Sartain, Texas Children's Hospital
• 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
• Sarak Vesely, Hudson College of Public Health
• John Wiernikowski, McMaster University
• Suzan Williams, The Hospital for Sick Children
• Hope P. Wilson, University of Alabama at Birmingham Heersink School of Medicine
• Gary Woods, Emory University School of Medicine
• Reem A. Mustafa, The University of Kansas Health System

Document Type

Article

Journal Title

Blood Advances

Publication Date

2026

Volume

10

Abstract

High-quality data on anticoagulant prophylaxis for pediatric VTE prevention are scarce. Key research priorities include the development and validation of subgroups-specific VTE risk assessment models, and evaluation of the safety and efficacy of risk-stratified anticoagulant prophylaxis strategies across different pediatric subgroups.

BACKGROUND: Venous thromboembolism (VTE) is a significant cause of morbidity in children, particularly among hospitalized patients and those with chronic medical conditions. There is a lack of consensus on anticoagulant prophylaxis strategies.

OBJECTIVE: These evidence-based guidelines from the American Society of Hematology (ASH) and the International Society on Thrombosis and Haemostasis (ISTH) are intended to support patients and health care professionals in decisions about anticoagulant prophylaxis for pediatric VTE prevention.

METHODS: ASH formed a multidisciplinary guideline panel that included 1 patient representative. The University of Kansas Health System supported the guideline development process, including systematic evidence reviews up to April 2025. Clinical questions and outcomes were prioritized according to their importance for clinicians and patients. The panel used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to assess certainty in the evidence and make recommendations.

RESULTS: The panel agreed on 12 recommendations. For pediatric patients with solid cancer, who have experienced trauma, or who are critically ill, the panel issued conditional recommendations suggesting no anticoagulant prophylaxis. For pediatric patients with antiphospholipid antibody syndrome, or those on long-term total parenteral nutrition, the panel issued conditional recommendations suggesting the use of anticoagulant prophylaxis. Other pediatric subgroups addressed included patients with acute lymphoblastic leukemia or lymphoma, surgical and hospitalized patients, and those with a central venous access device.

CONCLUSIONS: High-quality data on anticoagulant prophylaxis for pediatric VTE prevention are scarce. Key research priorities include the development and validation of subgroups-specific VTE risk assessment models, and evaluation of the safety and efficacy of risk-stratified anticoagulant prophylaxis strategies across different pediatric subgroups.

MeSH Headings

Humans, Venous Thromboembolism, Anticoagulants, Child, Risk Factors

DOI Link

10.1182/bloodadvances.2025019415

ISSN

2473-9537

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Recommended Citation

Betensky, Marisol; Azzam, Muayad; Bercovitz, Rachel; Bhat, Rukhmi V.; Biss, Tina; Branchford, Brian; Brandão, Leonardo R.; Chan, Anthony K.C.; Faustino, E. Vincent S.; Hamarsha, Qais; Jaffray, Julie; Jones, Sophie; Kawtharany, Hassan; Kerlin, Bryce A.; Khawandi, Jana; Krider, Grace; Kucine, Nicole; Kumar, Riten; Male, Christoph; Monagle, Paul; Pelland-Marcotte, Marie-Claude; Raffini, Leslie; Raulji, Chittalsinh M.; Sartain, Sarah E.; Takemoto, Clifford M.; Tarango, Cristina; Heleen van Ommen, C.; Velez, Maria C.; Vesely, Sarak; Wiernikowski, John; Williams, Suzan; Wilson, Hope P.; Woods, Gary; and Mustafa, Reem A., "ASH/ISTH 2026 Guidelines for Anticoagulant Prophylaxis in Pediatric Patients at Risk of Venous Thromboembolism" (2026). Journal Articles: Pediatrics. 58.
https://digitalcommons.unmc.edu/com_peds_articles/58