JTH in Clinic: Venous Thromboembolism (VTE) Prophylaxis of Pediatric Patients at Risk of VTE.

Authors

Hilary Whitworth, Sarah M Connor, Hollie Gilmore, Amy L Kiskaddon, Paul Monagle, Marisol Betensky

Published in

Journal of thrombosis and haemostasis : JTH. Oct 26, 2026. Epub Oct 26, 2026.

Abstract

As the incidence of venous thromboembolism (VTE) increases in hospitalized children, there is an urgent need to improve VTE prevention strategies in this population. Implementation of thromboprophylaxis, which includes mechanical and pharmacological interventions, varies in practice due to limited pediatric-specific data and, until recently, a lack of evidence-based guidelines. However, recent randomized clinical trials and well-designed multicenter observational studies have provided improved evidence on the safety and efficacy of anticoagulants for VTE prevention in specific pediatric subpopulations supporting the development of risk assessment models to help identify subgroups of children at high risk for VTE. Based on these data, the American Society of Hematology and International Society on Thrombosis and Haemostasis recently developed the first evidence-based guideline for anticoagulant prophylaxis in children at risk of VTE. While this guideline is an exciting step towards preventing VTE-associated harm, VTE prevention remains complex due to unique pediatric risk factors and changing physiology with age, resulting in heterogeneous VTE and bleeding risk profiles. In this case-based review, we apply the new guideline and supporting evidence to guide decisions regarding the use of thromboprophylaxis in pediatric cases commonly encountered in clinical practice, highlighting the nuances of VTE prevention in critically ill children. We review the complex decision-making process required prior to initiation of pharmacologic prophylaxis, including assessment of VTE risk, bleeding risk, and shared decision-making with families. Additionally, we highlight the importance of multidisciplinary teams in VTE prevention and anticoagulant stewardship, as well as the similarities and differences in pediatric versus adult practice.

PMID:
42933654
Bibliographic data and abstract were imported from PubMed on 27 Oct 2026.

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