Background: The American Society of Hematology (ASH) guidelines on treatment of pediatric venous thromboembolism (VTE) were published in 2018. In the last 6 years, there has been a 10-fold increase in the number of children involved in VTE treatment trials. Objective: The ASH Committee on Quality and Guidelines agreed to update the pediatric guidelines in conjunction with the International Society on Thrombosis and Haemostasis (ISTH). These ASH/ISTH evidence-based guidelines are intended to support patients, clinicians, and other health care professionals in the management of pediatric patients with VTE. Methods: ASH/ISTH formed a multidisciplinary guideline panel to minimize potential bias from conflicts of interest. An unconflicted patient representative was not identified. The University of Kansas Health System supported the guideline development process, updating or performing systematic evidence reviews up to 2024. The panel focused specifically on the 2018 questions for which there was the greatest amount of interim data. The panel used the GRADE (Grades of Recommendation,Assessment, Development, and Evaluation) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 20 recommendations and also provided implementation guidance on the optimal use of anticoagulants in pediatric patients. Key recommendations of these guidelines include the role of DOACs in the treatment of a variety of pediatric VTEs. Conclusions: Further research is required. Key priorities are understanding the natural history of clinically unsuspected thrombosis across a range of patient subpopulations and obtaining real-world data on the use of DOACs in children.

背景：美国血液学会（American Society of Hematology， ASH）于2018年发布了儿童静脉血栓栓塞症（venous thromboembolism， VTE）治疗指南。在过去的6年中，参与VTE治疗试验的儿童数量增加了10倍。目的：美国血液学会（ASH）质量和指南委员会同意联合国际血栓与止血学会（ISTH）更新儿科指南。这些ASH/ISTH循证指南旨在为患者、临床医师和其他医疗专业人员管理VTE患儿提供支持。方法：ASH/ISTH成立了多学科指南专家组，以减少潜在的利益冲突偏倚。未找到无利益冲突的患者代表。堪萨斯大学卫生系统（University of Kansas Health System）支持指南制定过程，截至2024年更新或实施了系统性证据审查。该小组特别关注了中期数据最多的2018年问题。该小组使用GRADE（Grades of Recommendation, Assessment, Development, and Evaluation）方法，包括GRADE证据到决策框架，评估证据并提出建议，并听取公众意见。结果：专家组达成了20条推荐意见，并提供了儿科患者抗凝药物最佳使用的实施指导。这些指南的关键建议包括直接口服抗凝剂（DOACs）在各种小儿静脉血栓栓塞治疗中的作用。结论：尚需进一步研究。关键的优先事项是了解一系列患者亚群中临床未怀疑的血栓形成的自然史，并获得儿童使用DOACs的真实数据。