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ESMINT-ESNR-IPSO-SNIS-WFITN guidelines on antiplatelet therapy in pediatric neurointervention: practical

Sophia Hohenstatt1,2, Lucie Thibault3, Darren B Orbach4

  • 1Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany sophia.hohenstatt@med.uni-heidelberg.de.

Journal of Neurointerventional Surgery
|June 11, 2026
PubMed

Insights

This guideline offers expert recommendations for antiplatelet therapy in pediatric neurointerventional procedures, addressing common scenarios and specific drug considerations for safer patient care.

Area of Science:

  • Neuroscience
  • Pediatric Medicine
  • Pharmacology

Background:

  • Pediatric neurointerventional procedures are rising, but antiplatelet management lacks pediatric-specific evidence.
  • Current practices often rely on adult data, leading to empirical or extrapolated treatment.
  • Limited research necessitates standardized guidelines for this vulnerable population.

Purpose of the Study:

  • To provide scenario-based recommendations for antiplatelet therapy in children undergoing neurointerventional procedures.
  • To integrate expert consensus from leading pediatric neurointerventional societies.
  • To address dosing, administration, and monitoring for various antiplatelet agents.

Main Methods:

  • A comprehensive scoping literature review was conducted.
  • Institutional protocols from experienced pediatric neurointerventional specialists were integrated.
  • An iterative consensus process involving multiple international societies guided the recommendations.

Main Results:

  • Recommendations are organized around common clinical scenarios, including aneurysm treatment and thromboembolic complications.
  • Specific guidance is provided for aspirin, clopidogrel, prasugrel, ticagrelor, cangrelor, and glycoprotein IIb/IIIa inhibitors.
  • Considerations for age-dependent pharmacokinetics, renal function, and platelet-function testing are included.

Conclusions:

  • These expert-consensus recommendations aim to improve the safety and consistency of antiplatelet management in pediatric neurointerventional procedures.
  • The guidelines acknowledge the need for individualized clinical judgment.
  • Further prospective pediatric studies are crucial to refine antiplatelet strategies.

Keywords:
InterventionPediatricsPharmacology

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