Pediatric VTE prophylaxis: What the new ASH–ISTH guidelines recommend

Clinical Takeaway: Don’t default to anticoagulant prophylaxis in hospitalized children. The 2026 ASH–ISTH guideline emphasizes selective, risk-based use, recommending against routine prophylaxis for many common pediatric conditions while identifying a small number of higher‑risk subgroups who may benefit.

What’s New—and Why It Matters

Venous thromboembolism (VTE) is increasingly recognized as a major source of preventable harm in children, particularly those who are hospitalized or medically complex. Yet until now, clinicians have had little pediatric‑specific guidance and have often relied on adult data.

The 2026 ASH–ISTH clinical practice guideline, published in Blood Advances, directly addresses this gap with 12 evidence‑based recommendations and two good practice statements focused on non‑cardiac pediatric patients at risk for VTE.

“This patient group is often among the most vulnerable and medically complex we treat, and clinicians have long lacked clear guidance on how to best care for them,” said Robert Negrin, MD, President of ASH. “These guidelines mark an important step in establishing clinical consensus to improve care and outcomes for children.”

Key Recommendations at a Glance

Conditional recommendations against routine anticoagulant prophylaxis in several common pediatric scenarios, including:

• Solid tumors
• Trauma
• Critical illness

These reflect uncertainty about net benefit and concern for bleeding risk in heterogeneous populations.

Conditional support for prophylaxis in select high‑risk groups, notably:

• Antiphospholipid antibody syndrome
• Children receiving long‑term total parenteral nutrition (TPN)

These groups have more consistently elevated thrombotic risk profiles.

Strong emphasis on individualized decision‑making, weighing thrombosis risk against bleeding risk, feasibility, and patient/family values—rather than applying blanket protocols.

Operational “good practice” guidance, including the need for institutional protocols to safely interrupt prophylaxis around lumbar puncture or spinal/epidural anesthesia, to reduce procedure‑related bleeding complications.

Why it matters

Hospital‑acquired VTE is now the second most common cause of preventable harm in children, yet overuse of anticoagulation carries real bleeding risk. This guideline provides a long‑needed framework to help clinicians avoid unnecessary prophylaxis while identifying children most likely to benefit.

Source: Betensky M, et al. (2026, April 8). Blood Adv. ASH ISTH 2026 guidelines for Anticoagulant Prophylaxis of Pediatric Patients at Risk of Venous Thromboembolism