The American Society of Haematology (ASH) and the International Society on Thrombosis and Haemostasis (ISTH) released comprehensive clinical practice guidelines on anticoagulant prophylaxis in non-cardiac paediatric 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,” said ASH President Robert Negrin, MD.

“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.”

VTE, or the formation of blood clots in veins, has become more common in paediatric patients over the past few decades, particularly among children who are hospitalised 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 paediatric 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 leukaemia 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 anaesthesia 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 paediatric subgroups.

“Prior to the development of these clinical guidelines, much of the data we referenced for VTE prevention in paediatric patients was extrapolated from adults, whose risk profiles are generally less varied and complex,” said Marisol Betensky, MD, MPH, associate professor of paediatrics in the division of haematology at Johns Hopkins University School of Medicine, paediatric haematologist 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 haematology.org/VTE.

Article: ASH ISTH 2026 guidelines for Anticoagulant Prophylaxis of Pediatric Patients at Risk of Venous Thromboembolism

Source: American Society of Hematology