Paul Monagle1, Carlos A Cuello2,3, Caitlin Augustine4, Mariana Bonduel5, Leonardo R Brandão6, Tammy Capman7, Anthony K C Chan8, Sheila Hanson9, Christoph Male10, Joerg Meerpohl11, Fiona Newall12,13, Sarah H O'Brien14, Leslie Raffini15, Heleen van Ommen16, John Wiernikowski17, Suzan Williams18, Meha Bhatt2, John J Riva2,19, Yetiani Roldan2, Nicole Schwab2, Reem A Mustafa2,20, Sara K Vesely21. 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.
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.
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.
Authors: Gordon H Guyatt; Andrew D Oxman; Regina Kunz; David Atkins; Jan Brozek; Gunn Vist; Philip Alderson; Paul Glasziou; Yngve Falck-Ytter; Holger J Schünemann Journal: J Clin Epidemiol Date: 2010-12-30 Impact factor: 6.437
Authors: Holger J Schünemann; Lubna A Al-Ansary; Frode Forland; Sonja Kersten; Jorma Komulainen; Ina B Kopp; Fergus Macbeth; Susan M Phillips; Craig Robbins; Philip van der Wees; Amir Qaseem Journal: Ann Intern Med Date: 2015-10-06 Impact factor: 25.391
Authors: Gordon H Guyatt; Andrew D Oxman; Gunn E Vist; Regina Kunz; Yngve Falck-Ytter; Pablo Alonso-Coello; Holger J Schünemann Journal: BMJ Date: 2008-04-26
Authors: N A Goldenberg; T Abshire; P J Blatchford; L Z Fenton; J L Halperin; W R Hiatt; C M Kessler; J M Kittelson; M J Manco-Johnson; A C Spyropoulos; P G Steg; N V Stence; A G G Turpie; S Schulman Journal: J Thromb Haemost Date: 2015-08-11 Impact factor: 5.824
Authors: Christine A Sabapathy; Tina N Djouonang; Susan R Kahn; Robert W Platt; Vicky Tagalakis Journal: J Pediatr Date: 2016-03-03 Impact factor: 4.406
Authors: M Andrew; M David; M Adams; K Ali; R Anderson; D Barnard; M Bernstein; L Brisson; B Cairney; D DeSai Journal: Blood Date: 1994-03-01 Impact factor: 22.113
Authors: Ariel Izcovich; Adam Cuker; Robert Kunkle; Ignacio Neumann; Julie Panepinto; Menaka Pai; Matthew Seftel; Matthew C Cheung; Richard Lottenberg; Michael Byrne; Robert Plovnick; Deirdra Terrell; Jennifer L Holter-Chakrabarty; Benjamin Djulbegovic; Lisa K Hicks; Wojtek Wiercioch; Robby Nieuwlaat; Holger J Schünemann Journal: Blood Adv Date: 2020-05-12
Authors: Wojtek Wiercioch; Robby Nieuwlaat; Elie A Akl; Robert Kunkle; Kendall E Alexander; Adam Cuker; Anita Rajasekhar; Pablo Alonso-Coello; David R Anderson; Shannon M Bates; Mary Cushman; Philipp Dahm; Gordon Guyatt; Alfonso Iorio; Wendy Lim; Gary H Lyman; Saskia Middeldorp; Paul Monagle; Reem A Mustafa; Ignacio Neumann; Thomas L Ortel; Bram Rochwerg; Nancy Santesso; Sara K Vesely; Daniel M Witt; Holger J Schünemann Journal: Blood Adv Date: 2020-05-26
Authors: Ruchika Goel; Cassandra D Josephson; Eshan U Patel; Molly R Petersen; Sarah Makhani; Steven M Frank; Paul M Ness; Evan M Bloch; Eric A Gehrie; Parvez M Lokhandwala; Marianne M Nellis; Oliver Karam; Beth H Shaz; Ravi M Patel; Aaron A R Tobian Journal: Pediatrics Date: 2020-03-20 Impact factor: 7.124
Authors: Katharina Thom; Anthonie W A Lensing; Ildar Nurmeev; Fanny Bajolle; Damien Bonnet; Gili Kenet; M Patricia Massicotte; Zeynep Karakas; Joseph S Palumbo; Paola Saracco; Pascal Amedro; Juan Chain; Anthony K Chan; Takanari Ikeyama; Joyce C M Lam; Cynthia Gauger; Ákos Ferenc Pap; Madhurima Majumder; Dagmar Kubitza; William T Smith; Scott D Berkowitz; Martin H Prins; Paul Monagle; Guy Young; Christoph Male Journal: Blood Adv Date: 2020-10-13
Authors: R Mark Payne; Kristin M Burns; Andrew C Glatz; Danshi Li; Xiaodong Li; Paul Monagle; Jane W Newburger; Elizabeth A Swan; Olivia Wheaton; Christoph Male Journal: Am Heart J Date: 2019-08-09 Impact factor: 4.749
Authors: Laura Avila; Noelle Cullinan; Michael White; Marian Gaballah; Anne Marie Cahill; Deepti Warad; Vilmarie Rodriguez; Cristina Tarango; Anna Hoppmann; Stephen Nelson; Tomas Kuhn; Tina Biss; Aaron Weiss; Michael Temple; João G Amaral; Nour Amiri; Ana C Xavier; Samuele Renzi; Leonardo R Brandão Journal: J Thromb Haemost Date: 2021-04-01 Impact factor: 5.824