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ASH/ISTH 2026 guidelines for anticoagulant prophylaxis in pediatric patients at risk of venous thromboembolism

Marisol Betensky1,2, Muayad Azzam3, Rachel Sara Bercovitz4

  • 1Division of Hematology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.

Blood Advances
|April 8, 2026
PubMed

Insights

Guidelines now exist for preventing pediatric venous thromboembolism (VTE) with anticoagulant prophylaxis. Recommendations vary by patient subgroup, with some advised against prophylaxis and others advised for it.

Area of Science:

  • Pediatric Hematology
  • Thrombosis and Hemostasis
  • Clinical Guidelines

Background:

  • Venous thromboembolism (VTE) is a major cause of illness in children, especially those hospitalized or with chronic conditions.
  • Current anticoagulant prophylaxis strategies for pediatric VTE lack consensus.

Purpose of the Study:

  • To provide evidence-based guidelines for anticoagulant prophylaxis in pediatric VTE prevention.
  • To support shared decision-making between patients and healthcare professionals.

Main Methods:

  • A multidisciplinary panel, including a patient representative, developed the guidelines.
  • Systematic evidence reviews were conducted up to April 2025.
  • The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess evidence certainty and formulate recommendations.

Main Results:

  • Twelve recommendations were established for pediatric VTE prophylaxis.
  • Conditional recommendations against prophylaxis were made for critically ill children, those with cancer, or trauma.
  • Conditional recommendations for prophylaxis were issued for children with antiphospholipid antibody syndrome or on long-term total parenteral nutrition.

Conclusions:

  • High-quality data for pediatric VTE prophylaxis are limited.
  • Future research should focus on VTE risk assessment models and risk-stratified prophylaxis strategies for pediatric subgroups.

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