Key result
Pediatric cardiac antithrombotic studies feature anticoagulation in ~57% of patients, with inconsistent bleeding definitions.
Why the study?
Children with cardiac disease have an increased risk of thromboembolism, and antithrombotic treatment and thromboprophylaxis regimens vary across institutions, settings, and scenarios. This study sought to characterize prospective studies and clinical trials reporting antithrombotic regimens and associated bleeding and thromboembolism outcomes across pediatric cardiac contexts.
Systematic Review (n=6,754)
This 20-year systematic review of 47 prospective studies and trials in pediatric cardiac disease highlights that primary thromboprophylaxis is the most common antithrombotic indication, but regimen details are often incomplete and standardized outcome definitions are underutilized.
Answers are grounded in this paper and cite their sources.
Widespread anticoagulation use in pediatric cardiac antithrombotic regimens; leaves open need for standardized efficacy trials with uniform bleeding definitions.
Background Children with cardiac disease have increased risk of thromboembolism (TE), compared to the general pediatric population. Antithrombotic treatment and thromboprophylaxis regimens vary across institutions, settings, and scenarios. Objectives To characterize prospective studies and clinical trials reporting antithrombotic treatment and thromboprophylaxis regimens and associated bleeding and TE outcomes across pediatric cardiac contexts. Methods PubMed, Embase, Web of Science, and Cochrane CENTRAL were searched for prospective studies (registry, cohort, clinical trials) enrolling patients < 21 years of age with congenital or acquired heart disease who received antithrombotic (anticoagulant or antiplatelet) medication(s) for TE treatment or prophylaxis. Antithrombotic regimens, TE events, and bleeding rates, and use of standardized outcome definitions recommended by international consensus bodies were applied to report outcomes. Descriptive statistics were utilized. Results Forty-seven studies (4 registry, 33 prospective cohorts, 10 randomized clinical trials) were included, totaling 6754 patients. Twenty-eight studies (N=5161) were designed to evaluate antithrombotic safety and efficacy; 19 studies (N=1593) evaluated other outcomes but included antithrombotic regimens. Indications included primary thromboprophylaxis (42 studies), TE treatment (6 studies), and secondary thromboprophylaxis (4 studies). Bleeding using a standardized definition was reported in 19/47 (40.4%) studies. Anticoagulation was used in 3,876 patients (57.4%), and antiplatelets in 2854 (42.3%) patients. Conclusions Across 47 studies in 6754 children, primary thromboprophylaxis was the most common indication; regimen detail was frequently incomplete in studies not designed to assess antithrombotic outcomes, and few studies utilized standardized outcome definitions. Robust prospective cohort studies and trials employing standardized outcome definitions are needed.
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Kiskaddon et al. (2026) conducted a systematic review in Pediatric congenital or acquired heart disease (n=6,754). Antithrombotic (anticoagulant or antiplatelet) medication was evaluated on Antithrombotic regimens, thromboembolism events, bleeding rates, and use of standardized outcome definitions. Antithrombotic therapy in 6,754 pediatric cardiac patients across 47 studies included anticoagulation (57.4%) and antiplatelets (42.3%), with 40.4% of studies using standardized bleeding definitions.
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