New clinical guidelines address blood clot prevention in pediatric patients

The American Society of Hematology (ASH) and the International Society on Thrombosis and Haemostasis (ISTH) released comprehensive clinical practice guidelines on anticoagulant prophylaxis in non-cardiac pediatric patients at risk of venous thromboembolism (VTE). The guidelines were developed by an expert panel following a rigorous review process and published in ASH's peer-reviewed journal, Blood Advances.

This patient group is often among the most vulnerable and medically complex we treat, and clinicians have long lacked clear guidance on how to best care for them. These guidelines mark an important step in establishing clinical consensus to improve care and outcomes for children facing serious, life-threatening conditions. The Society is pleased to have collaborated with ISTH on this urgently needed project."

Robert Negrin, MD, ASH President 

VTE, or the formation of blood clots in veins, has become more common in pediatric patients over the past few decades, particularly among children who are hospitalized or have a chronic condition like cancer, which can lead to significant short- and long-term complications. Hospital-acquired VTE is the second most common cause of preventable harm in children, yet there has been little consensus on which patients should receive preventive care and what that care should involve.

"The ISTH is proud to partner with ASH on the important joint guidelines addressing venous thromboembolism in pediatric patients," said ISTH President Pantep Angchaisuksiri, MD. "This collaboration reflects a shared commitment to advancing evidence-based care and provides clinicians with the tools to better treat and prevent blood clots in children worldwide."

Grounded in the latest research, the guidelines were developed by a multidisciplinary expert panel as well as a lived experience expert, and present twelve recommendations and two good practice statements on administering anticoagulant prophylaxis, or preventive care, to children at risk of developing VTE. The guidelines include:

• Conditional recommendations suggesting no anticoagulant prophylaxis in children with solid cancer, trauma, or a critical illness
• Conditional recommendations suggesting anticoagulant prophylaxis in children who have antiphospholipid syndrome or are on long-term total parenteral nutrition
• Counsel on administering anticoagulant prophylaxis in patient subgroups including children with acute lymphoblastic leukemia or lymphoma, a central venous access device, or who have recently undergone surgery

Additionally, the guidelines encourage institutions to develop protocols for managing interruptions to therapy, particularly for those undergoing lumbar puncture or spinal anesthesia procedures. They also highlight the need for further research to develop VTE risk assessment models for this population and to evaluate the safety and efficacy of prophylaxis across different pediatric subgroups.

"Prior to the development of these clinical guidelines, much of the data we referenced for VTE prevention in pediatric patients was extrapolated from adults, whose risk profiles are generally less varied and complex," said Marisol Betensky, MD, MPH, associate professor of pediatrics in the division of hematology at Johns Hopkins University School of Medicine, pediatric hematologist in the Johns Hopkins All Children's Cancer & Blood Disorders Institute, and co-chair of the guidelines. "These guidelines provide physicians with an evidence-based framework to make decisions about VTE prophylaxis for children."

Additional guidelines resources, including visual summaries, and teaching slides, can be accessed at hematology.org/VTE.

ASH and ISTH previously developed revised clinical practice guidelines for pediatric VTE treatment.