The American Society of Hematology (ASH) and the International Society on Thrombosis and Haemostasis (ISTH) have released a set of comprehensive clinical practice guidelines for the use of anticoagulant prophylaxis in pediatric patients at risk of venous thromboembolism. The guidelines were published in 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 Robert Negrin, MD, President of ASH. “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.”
“The ISTH is proud to partner with ASH on the important joint guidelines addressing venous thromboembolism in pediatric patients,” said Pantep Angchaisuksiri, MD, President of ISTH. “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.”
Background
Venous thromboembolism has become increasingly more common in pediatric patients, with hospital-acquired venous thromboembolism now the second most common cause of preventable harm in children. However, researchers have yet to agree upon preventive care and who should receive it.
A multidisciplinary expert panel, which included one patient representative with lived experience, was gathered to create this set of evidence-based guidelines for prophylactic treatment for pediatric patients at risk of developing venous thromboembolism. Certainty in the evidence for recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Recommendations
The guidelines include 12 recommendations and two good practice statements for the administration of anticoagulant prophylaxis in pediatric patients at risk of developing venous thromboembolism.
Conditionally, the guidelines do not recommend anticoagulant prophylaxis for pediatric patients with solid cancer, trauma, or a critical illness. They are recommended for pediatric patients with antiphospholipid syndrome or who are on long-term total parenteral nutrition.
The guidelines also addressed other pediatric subgroups, including patients with acute lymphoblastic leukemia or lymphoma, surgical and hospitalized patients, and those with a central venous access device. For these patients, the guidelines recommended addressing individual risk assessment for risk of thrombosis and bleeding for each case. Pediatric patients with leukemia/lymphoblastic lymphoma, however, were recommended not to receive antithrombin supplementation.
“Prior to the development of these clinical guidelines, much of the data we referenced for venous thromboembolism prevention in pediatric patients was extrapolated from adults, whose risk profiles are generally less varied and complex,” said guidelines co-chair 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. “These guidelines provide physicians with an evidence-based framework to make decisions about venous thromboembolism prophylaxis for children.”
The panel and study authors noted that “Key research priorities include the development and validation of subgroup-specific venous thromboembolism risk assessment models, and evaluation of the safety and efficacy of risk-stratified anticoagulant prophylaxis strategies across different pediatric subgroups.”
The joint groups have already previously developed clinical practice guidelines for the treatment of pediatric patients with venous thromboembolism.
DISCLOSURES: For full disclosures of the study authors, visit ashpublications.org.
