ASH and ISTH Release Comprehensive VTE Prophylaxis Guidelines for Non-Cardiac Pediatric Patients
The American Society of Hematology (ASH) and the International Society on Thrombosis and Haemostasis (ISTH) have jointly released comprehensive clinical practice guidelines for anticoagulant prophylaxis in non-cardiac pediatric patients at risk of venous thromboembolism (VTE). Published in ASH's peer-reviewed journal Blood Advances, these guidelines aim to provide an evidence-based framework for preventing blood clots in children, addressing a previous lack of specific consensus and reliance on adult data.
Background on Pediatric Venous Thromboembolism (VTE)
Venous thromboembolism (VTE), which involves the formation of blood clots in veins, has become increasingly prevalent in pediatric patients over recent decades. This is particularly noted among children who are hospitalized or have chronic conditions such as cancer. Hospital-acquired VTE is identified as the second most common cause of preventable harm in children.
Prior to the release of these new guidelines, there was limited consensus on which pediatric patients should receive preventive care, with much of the data referenced often extrapolated from adult studies.
Development and Purpose of the Guidelines
An expert panel, which included multidisciplinary specialists and a lived experience expert, developed the guidelines. They present twelve recommendations and two good practice statements on administering anticoagulant prophylaxis. The purpose of these guidelines is to establish clinical consensus and improve care by providing an evidence-based framework specifically for pediatric VTE prophylaxis, recognizing the varied and complex risk profiles in children.
Key Recommendations for Anticoagulant Prophylaxis
The guidelines provide conditional recommendations regarding the administration of anticoagulant prophylaxis:
- Conditional Recommendations Against Prophylaxis: No anticoagulant prophylaxis is suggested for children diagnosed with solid cancer, trauma, or a critical illness.
- Conditional Recommendations For Prophylaxis: Anticoagulant prophylaxis is suggested for children with antiphospholipid syndrome or those on long-term total parenteral nutrition.
- Guidance on Administration: Guidance is provided for administering anticoagulant prophylaxis in patient subgroups, including children with acute lymphoblastic leukemia or lymphoma, those with a central venous access device, or those who have recently undergone surgery.
Institutional Protocols and Future Research
The guidelines encourage institutions to develop specific protocols for managing interruptions to anticoagulant therapy, particularly for patients undergoing procedures such as lumbar puncture or spinal anesthesia. They also emphasize the ongoing need for further research to develop VTE risk assessment models tailored for the pediatric population and to evaluate the safety and efficacy of prophylaxis across diverse pediatric subgroups. This push for future research is crucial for advancing pediatric VTE prevention.
Expert Commentary
Dr. Marisol Betensky, co-chair of the guidelines and an associate professor of pediatrics at Johns Hopkins University School of Medicine, stated that these guidelines provide physicians with an evidence-based framework for making decisions about VTE prophylaxis specifically for children, moving beyond data extrapolated from adult patients.
Additional Resources
Additional resources related to the guidelines, including visual summaries and teaching slides, are available on the ASH website, specifically at hematology.org/VTE. ASH and ISTH have a history of collaboration, having previously developed revised clinical practice guidelines for pediatric VTE treatment.