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Updated: May 9, 2026
International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
2026 American Association for Thoracic Surgery (AATS) expert consensus statement: Antithrombotic management of
M Nathan1, A Kiskaddon2, S Emani1
1Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Insights
The hemostatic system in infants with congenital heart disease differs significantly, requiring specialized antithrombotic management. This study provides expert consensus guidelines for periprocedural evaluation and therapy in this unique pediatric population.
Area of Science:
- Pediatric Cardiology
- Hematology
- Cardiovascular Surgery
Background:
- The hemostatic system in neonates and infants with congenital heart disease (CHD) is unique due to developmental and disease-specific factors.
- Current practice variations in antithrombotic management highlight a need for evidence-based guidance.
Purpose of the Study:
- To develop a unified management strategy for periprocedural antithrombotic testing and therapy in infants with CHD.
- To define differences in the hemostatic system of infants compared to older individuals.
Main Methods:
- Modified Delphi methodology was employed by a multidisciplinary expert panel.
- The panel comprised cardiac surgeons, cardiologists, interventionalists, hematologists, intensivists, and pharmacologists.
- The study focused on infants undergoing congenital cardiac interventions.
Main Results:
- Consensus was achieved on 34 statements regarding the hemostatic system in infants with CHD.
- Information provided covers the coagulation cascade, testing for abnormalities, and monitoring of antithrombotic agents.
- Recommendations address pre, intra, and postprocedural antithrombotic management, including procedure- and device-specific guidance.
Conclusions:
- The distinct hemostatic system in infants with CHD necessitates tailored periprocedural evaluation and antithrombotic therapy.
- These recommendations offer guidance for managing antithrombotic therapy during cardiac interventions in this vulnerable population.
Objectives:
The hemostatic system in neonates and infants with congenital heart disease is distinct as a result of developmental and disease-specific factors, necessitating population-specific periprocedural evaluation and antithrombotic management. Ongoing practice variation reflects limited evidence and highlights the need for structured guidance and further study.
Methods:
To develop a more unified management strategy for periprocedural antithrombotic testing and therapy in this vulnerable population, a group of experts (cardiac surgeons, cardiologists, interventionalist, hematologists, intensivists, and pharmacologists) commissioned by the American Association for Thoracic Surgery was convened to define the basic differences in the hemostatic systems of neonates and infants compared with older children and adults and develop a framework for periprocedural antithrombotic management in neonates and infants undergoing congenital cardiac interventions using the modified Delphi methodology.
Results:
Consensus was reached on all 34 statements and related figures and tables. These provide information specific to neonates and infants with congenital heart disease on the coagulation cascade; testing for congenital, acquired, and therapy-related abnormalities in the hemostatic system; and commonly used antithrombotic (anticoagulant and antiplatelet) agents and their monitoring. Recommendations were made on pre-, intra-, and postprocedural antithrombotic management, including procedure and device-specific recommendations both in the short and long term.
Conclusions:
The hemostatic system in neonates and infants with congenital heart disease is distinct from that of older children and adults and warrants focused periprocedural evaluation and therapy. These recommendations guide understanding of the complex interactions during antithrombotic management in this patient population during cardiac surgical and catheter-based interventions.
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