Monagle Paul, Azzam Muayad, Bercovitz Rachel, Betensky Marisol, Bhat Rukhmi, Biss Tina, Branchford Brian, Brandão Leonardo R, Chan Anthony K C, Faustino E Vincent S, Jaffray Julie, Jones Sophie, Kawtharany Hassan, Kerlin Bryce A, Kucine Nicole, Kumar Riten, Male Christoph, Pelland-Marcotte Marie-Claude, Raffini Leslie, Raulji Chittalsinh, Sartain Sarah E, Takemoto Clifford M, Tarango Cristina, van Ommen C Heleen, Velez Maria C, Vesely Sara K, Wiernikowski John, Williams Suzan, Wilson Hope P, Woods Gary, Zia Ayesha, Mustafa Reem A
Departments of Paediatrics and Haematology, The University of Melbourne, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Division of Nephrology, Department of Internal Medicine, Evidence-based Practice and Impact Center, The University of Kansas Health System, Kansas City, KS.
Blood Adv. 2025 May 27;9(10):2587-2636. doi: 10.1182/bloodadvances.2024015328.
The American Society of Hematology (ASH) guidelines on treatment of pediatric venous thromboembolism (VTE) were published in 2018. In the last 6 years, there has been a 10-fold increase in the number of children involved in VTE treatment trials.
The ASH Committee on Quality and Guidelines agreed to update the pediatric guidelines in conjunction with the International Society on Thrombosis and Haemostasis (ISTH). These ASH/ISTH evidence-based guidelines are intended to support patients, clinicians, and other health care professionals in the management of pediatric patients with VTE.
ASH/ISTH formed a multidisciplinary guideline panel to minimize potential bias from conflicts of interest. An unconflicted patient representative was not identified. The University of Kansas Health System supported the guideline development process, updating or performing systematic evidence reviews up to 2024. The panel focused specifically on the 2018 questions for which there was the greatest amount of interim data. The panel used the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.
The panel agreed on 20 recommendations and also provided implementation guidance on the optimal use of anticoagulants in pediatric patients. Key recommendations of these guidelines include the role of DOACs in the treatment of a variety of pediatric VTEs.
Further research is required. Key priorities are understanding the natural history of clinically unsuspected thrombosis across a range of patient subpopulations and obtaining real-world data on the use of DOACs in children.
美国血液学会（ASH）关于儿童静脉血栓栓塞症（VTE）治疗的指南于2018年发布。在过去6年中，参与VTE治疗试验的儿童数量增加了10倍。
ASH质量与指南委员会同意与国际血栓与止血学会（ISTH）联合更新儿童指南。这些基于ASH/ISTH证据的指南旨在支持患者、临床医生和其他医疗保健专业人员管理患有VTE的儿童患者。
ASH/ISTH成立了一个多学科指南小组，以尽量减少利益冲突带来的潜在偏倚。未确定无利益冲突的患者代表。堪萨斯大学健康系统支持指南制定过程，更新或进行截至2024年的系统证据审查。该小组特别关注2018年有最多中期数据的问题。该小组使用GRADE（推荐分级、评估、制定和评价）方法，包括GRADE证据到决策框架，来评估证据并提出建议，这些建议接受公众评论。
该小组就20项建议达成一致，并提供了儿童患者抗凝剂最佳使用的实施指南。这些指南的关键建议包括直接口服抗凝剂（DOACs）在治疗各种儿童VTE中的作用。
需要进一步研究。关键优先事项是了解一系列患者亚群中临床未怀疑血栓形成的自然史，并获取儿童使用DOACs的真实世界数据。
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