ASH and ISTH Publish Revised Clinical Practice Guidelines for Pediatric Venous Thromboembolism
New clinical guidelines recommend direct oral anticoagulants over current standard of care in many children
(WASHINGTON—May 27, 2025) The American Society of Hematology (ASH) and the International Society on Thrombosis and Haemostasis (ISTH) released new and updated clinical practice guidelines for the treatment of pediatric venous thromboembolism (VTE). The guidelines, published in ASH’s peer-reviewed journal Blood Advances, were developed by an expert panel following a rigorous review process. They aim to improve health outcomes by providing evidence-based recommendations for managing VTE in children.
The new and updated pediatric VTE clinical guidelines incorporate the latest research in the field and mark the first update to the guidelines since their publication in 2018. In total, 16 recommendations were updated and four were added. One of the most notable changes is the new recommendation for direct oral anticoagulants over standard-of-care anticoagulants. Specifically, this recommendation advises clinicians to consider dabigatran or rivaroxaban over therapies such as low molecular weight heparin and vitamin k antagonist.
“These evidence-based guidelines are a key resource for clinicians to improve the quality of care for this vulnerable population,” said Belinda R. Avalos, MD, ASH president. “The recommendations are updated to incorporate the latest science, and we are glad to have collaborated with the ISTH on this project.”
“Collaborating with ASH on these updated pediatric VTE guidelines reflects the ISTH’s commitment to ensuring that children affected by VTE receive the most effective, evidence-based care,” said Pantep Angchaisuksiri, MD, ISTH president. “It’s critical that we continue advancing research and education in this area to support better outcomes for young patients worldwide.”
VTE sometimes manifests as deep vein thrombosis, when a blood clot forms in the deep veins, or pulmonary embolism, when a blood clot blocks an artery in the lung. Although the incidence of VTE in children at a population level is very low, it is higher in children who are hospitalized and can be life-threatening.
“Thrombosis in children is an increasingly common complication in children with complex illnesses and conditions and, if not managed well, can impact long-term outcomes for these patients,” said Paul Monagle, MD, MBBS, MSc, a pediatric hematologist and professor of pediatrics at the University of Melbourne and chair of the ASH ISTH Guidelines on Treatment of Pediatric VTE. “The care of children is important, and parents should know that there is a body of evidence that supports their child’s treatment options.”
For more information about the ASH Clinical Practice Guidelines on Pediatric VTE, and to access additional resources, visit www.hematology.org/VTEguidelines.
About the American Society of Hematology
The American Society of Hematology (ASH) (hematology.org) is the world’s largest professional society of hematologists dedicated to furthering the understanding, diagnosis, treatment, and prevention of disorders affecting the blood. Since 1958, the Society has led the development of hematology as a discipline by promoting research, patient care, education, training, and advocacy in hematology.
The Blood journals (https://ashpublications.org/journals) are the premier source for basic, translational, and clinical hematological research. The Blood journals publish more peer-reviewed hematology research than any other academic journals worldwide.
About the International Society on Thrombosis and Haemostasis
Founded in 1969, the ISTH is the leading international medical and scientific professional organization dedicated to advancing the understanding, prevention, diagnosis and treatment of conditions related to thrombosis and hemostasis. The ISTH professional membership community includes more than 7,000 clinicians, researchers and educators from more than 120 countries working together to advance science and improve clinical care around the world. Among its highly-regarded activities and initiatives are education and standardization programs, research activities, meetings and congresses, clinical and laboratory practice guidance and guidelines, peer-reviewed publications, expert committees and World Thrombosis Day on 13 October. Learn more at www.isth.org.
Contact ASH:
Claire Whetzel, 202-629-5085
[email protected]
Contact ISTH:
Barbara Krolak
[email protected]