June 12, 2026Journal of NeuroInterventional Surgery0 citations

ESMINT-ESNR-IPSO-SNIS-WFITN guidelines on antiplatelet therapy in pediatric neurointervention: practical recommendations and dosing strategies

Q: What is the clinical evidence from this study?

Study design: Review. Population: Children undergoing neurointerventional procedures. Intervention: Antiplatelet therapy.

SHSophia HohenstattUniversität Hamburg LTLucie ThibaultBusiness Development Bank of Canada DODarren B. OrbachBoston Children's Hospital

Key Result

Expert-consensus guidelines provide scenario-based recommendations for antiplatelet therapy in pediatric neurointerventional procedures, addressing dosing, administration, and monitoring.

Key Points

The aim is to provide evidence-based guidelines for antiplatelet therapy in pediatric neurointerventions due to the lack of specific data.
Developed guidelines based on institutional protocols and literature review by pediatric neurointerventional specialists.
Consensus process involved multiple professional organizations and addressed scenario-specific recommendations.
Dosing strategies for various antiplatelet agents were included, considering age and renal function.
Recommendations for managing elective and emergency aneurysm treatment were established.
Dosing strategies for agents like aspirin and clopidogrel were detailed, tailored to pediatric needs.
Increased attention to individualized care and the need for future studies was emphasized.

Structured PICO

How should antiplatelet therapy be managed in children undergoing neurointerventional procedures?

Population

Children undergoing neurointerventional procedures

Intervention

Antiplatelet therapy (aspirin, clopidogrel, prasugrel, ticagrelor, cangrelor, and glycoprotein IIb/IIIa inhibitors)

This document provides comprehensive, multi-society expert consensus guidelines for antiplatelet therapy in pediatric neurointerventional procedures, addressing a critical gap in pediatric-specific evidence.

Limitations

Limited pediatric-specific evidence
Need for individualized clinical judgment and prospective pediatric studies

Abstract

Pediatric neurointerventional procedures are increasingly performed, yet antiplatelet management remains largely empirical or extrapolated from adult practice because of limited pediatric-specific evidence. This guideline provides scenario-based recommendations for antiplatelet therapy in children undergoing neurointerventional procedures; anticoagulant therapy will be addressed separately. Institutional protocols from experienced pediatric neurointerventional specialists were integrated with a comprehensive scoping literature review through an iterative consensus process involving the European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), International Pediatric Stroke Organization (IPSO), Society of NeuroInterventional Surgery (SNIS), and World Federation of Interventional and Therapeutic Neuroradiology (WFITN). Recommendations are organized around common clinical scenarios, including elective and emergency aneurysm treatment and the management of thromboembolic complications. Dosing, administration, and monitoring considerations are provided for aspirin, clopidogrel, prasugrel, ticagrelor, cangrelor, and glycoprotein IIb/IIIa inhibitors, with additional attention to age-dependent pharmacokinetics, renal function, available formulations, and platelet-function testing. These expert-consensus recommendations are intended to support safer and more consistent clinical practice while recognizing the need for individualized clinical judgment and prospective pediatric studies.

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