Recent Evidence for Preventing Venous Thromboembolism

Key Findings:The American Society of Hematology and the International Society on Thrombosis and Haemostasis suggest avoiding anticoagulant prophylaxis for pediatric patients undergoing noncardiac surgery.This recommendation is supported by low-level evidence regarding its effects.Further, homogeneous data suggest that these patients are low risk for venous thromboembolism (VTE).Notably, this evaluation summed data from various procedure types (eg, orthopedic, bariatric, laparoscopic) and did not investigate the specific risks associated with each procedure.Patients may be at higher risk if they undergo a procedure with a longer operative time, experience prolonged immobilization, require central venous access for more than seven days, have an obesity or congenital thrombophilia diagnosis, or use a combined oral contraceptive.Clinicians should carefully weigh the patient's risk of thrombosis against their risk of bleeding.Anticoagulants should not be administered to patients who are at risk of clinically relevant nonmajor bleeding, even if they are at risk of VTE.Significance: The American Society of Hematology and the International Society on Thrombosis and Haemostasis created an interdisciplinary panel to evaluate systematic evidence on pediatric anticoagulant prophylaxis strategies.Broad recommendations include avoiding anticoagulant prophylaxis in patients with solid tumors, who have experienced trauma, or who are critically ill.Anticoagulants may be considered for patients with antiphospholipid antibody syndrome or who require long-term total parenteral nutrition.The panel recommends developing institutional guidelines for VTE prophylaxis in surgical pediatric patients.For those who do receive anticoagulants, careful consideration of the timing and duration is advised.This is particularly helpful when caring for patients undergoing a lumbar puncture or spinal anesthetic procedure with a high risk of bleeding.