Practice Guideline

. 2018 Nov 27;2(22):3292-3316.

doi: 10.1182/bloodadvances.2018024786.

American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism

Paul Monagle¹, Carlos A Cuello^{2

3}, Caitlin Augustine⁴, Mariana Bonduel⁵, Leonardo R Brandão⁶, Tammy Capman⁷, Anthony K C Chan⁸, Sheila Hanson⁹, Christoph Male¹⁰, Joerg Meerpohl¹¹, Fiona Newall^{12

13}, Sarah H O'Brien¹⁴, Leslie Raffini¹⁵, Heleen van Ommen¹⁶, John Wiernikowski¹⁷, Suzan Williams¹⁸, Meha Bhatt², John J Riva^{2

19}, Yetiani Roldan², Nicole Schwab², Reem A Mustafa^{2

20}, Sara K Vesely²¹

Affiliations

¹ Department of Clinical Haematology, Royal Children's Hospital, University of Melbourne and Murdoch Children's Research Institute, VIC, Australia.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
³ Tecnologico de Monterrey School of Medicine, Monterrey, Mexico.
⁴ Boston, MA.
⁵ Department of Hematology/Oncology, Hospital de Pediatria "Prof. Dr. Juan P. Garrahan," Buenos Aires, Argentina.
⁶ Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
⁷ Melbourne, FL.
⁸ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁹ Department of Pediatrics, Medical College of Wisconsin and Critical Care Section, Children's Hospital of Wisconsin, Milwaukee, WI.
¹⁰ Department of Pediatrics, Medical University of Vienna, Vienna, Austria.
¹¹ Department of Medical Biometry and Statistics, Institute of Medical Biometry and Medical Informatics, University of Freiburg and University Medical Center Freiburg, Freiburg, Germany.
¹² Department of Clinical Haematology and.
¹³ Department of Nursing Research, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
¹⁴ Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
¹⁵ Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
¹⁶ Department of Pediatric Hematology, Sophia Children's Hospital Erasmus MC, Rotterdam, The Netherlands.
¹⁷ Division of Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
¹⁸ Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹⁹ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
²⁰ Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, KS; and.
²¹ Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.

PMID: 30482766
PMCID: PMC6258911
DOI: 10.1182/bloodadvances.2018024786

Practice Guideline

American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism

Paul Monagle et al. Blood Adv. 2018.

. 2018 Nov 27;2(22):3292-3316.

doi: 10.1182/bloodadvances.2018024786.

Authors

Affiliations

¹ Department of Clinical Haematology, Royal Children's Hospital, University of Melbourne and Murdoch Children's Research Institute, VIC, Australia.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
³ Tecnologico de Monterrey School of Medicine, Monterrey, Mexico.
⁴ Boston, MA.
⁵ Department of Hematology/Oncology, Hospital de Pediatria "Prof. Dr. Juan P. Garrahan," Buenos Aires, Argentina.
⁶ Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
⁷ Melbourne, FL.
⁸ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁹ Department of Pediatrics, Medical College of Wisconsin and Critical Care Section, Children's Hospital of Wisconsin, Milwaukee, WI.
¹⁰ Department of Pediatrics, Medical University of Vienna, Vienna, Austria.
¹¹ Department of Medical Biometry and Statistics, Institute of Medical Biometry and Medical Informatics, University of Freiburg and University Medical Center Freiburg, Freiburg, Germany.
¹² Department of Clinical Haematology and.
¹³ Department of Nursing Research, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
¹⁴ Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
¹⁵ Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
¹⁶ Department of Pediatric Hematology, Sophia Children's Hospital Erasmus MC, Rotterdam, The Netherlands.
¹⁷ Division of Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
¹⁸ Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹⁹ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
²⁰ Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, KS; and.
²¹ Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.

PMID: 30482766
PMCID: PMC6258911
DOI: 10.1182/bloodadvances.2018024786

Abstract

Background: Despite an increasing incidence of venous thromboembolism (VTE) in pediatric patients in tertiary care settings, relatively few pediatric physicians have experience with antithrombotic interventions.

Objective: These guidelines of the American Society of Hematology (ASH), based on the best available evidence, are intended to support patients, clinicians, and other health care professionals in their decisions about management of pediatric VTE.

Methods: ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews (up to April of 2017). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.

Results: The panel agreed on 30 recommendations, covering symptomatic and asymptomatic deep vein thrombosis, with specific focus on management of central venous access device-associated VTE. The panel also addressed renal and portal vein thrombosis, cerebral sino venous thrombosis, and homozygous protein C deficiency.

Conclusions: Although the panel offered many recommendations, additional research is required. Priorities include understanding the natural history of asymptomatic thrombosis, determining subgroup boundaries that enable risk stratification of children for escalation of treatment, and appropriate study of newer anticoagulant agents in children.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: All authors were members of the guideline panel, members of the systematic review team, or both. As such, they completed a disclosure of interest form, which was reviewed by ASH and are available as Supplements 2 and 3.

Comment in

The value of the old and the new.
Monagle P, Male C, Raffini L. Monagle P, et al. Blood Adv. 2023 Jul 25;7(14):3683-3685. doi: 10.1182/bloodadvances.2023009723. Blood Adv. 2023. PMID: 36939386 Free PMC article. No abstract available.

References

1. Schünemann HJ, Wiercioch W, Etxeandia I, et al. . Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ. 2014;186(3):E123-E142. - PMC - PubMed
1. Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Board on Health Care Services; Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E, eds. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Press; 2011. - PubMed
1. Qaseem A, Forland F, Macbeth F, Ollenschläger G, Phillips S, van der Wees P; Board of Trustees of the Guidelines International Network. Guidelines International Network: toward international standards for clinical practice guidelines. Ann Intern Med. 2012;156(7):525-531. - PubMed
1. Schünemann HJ, Al-Ansary LA, Forland F, et al. ; Board of Trustees of the Guidelines International Network. Guidelines International Network: principles for disclosure of interests and management of conflicts in guidelines. Ann Intern Med. 2015;163(7):548-553. - PubMed
1. Langer G, Meerpohl JJ, Perleth M, Gartlehner G, Kaminski-Hartenthaler A, Schünemann H. [GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables]. Z Evid Fortbild Qual Gesundhwes. 2012;106(5):357-368. - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Research Materials
- NCI CPTC Antibody Characterization Program
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism

Affiliations

American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous