Recommendations

Document Overview

Design and created by Guideline Central in participation with the American College of Chest Physicians.

Antithrombotic Therapy In Neonates And Children

American College of Chest Physicians

Publication Date: Feb 1, 2012

Page Last Updated: May 5, 2026

Grading Recommendations

Grade	Description
1	Recommendation: indicates confidence that the benefits of the intervention clearly outweigh harms.
2	Suggestion: indicates greater uncertainty: although the benefits of the statement are still viewed as outweighing the harms, balance of benefits and harms is more difficult to judge, or the benefits or the harms may be less clear. With a suggestion, patient values and preferences may be more variable, and this can influence the clinical decision that is ultimately made.
Grade	Strength of Evidence
A	High: high confidence that the evidence reflects the true effect. Further research is very unlikely to change our confidence in the estimate of effect.
B	Moderate: moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of effect and may change the estimate.
C	Low: low confidence that the evidence reflects the true effect. Further research is likely to change our confidence in the estimate of effect and is likely to change the estimate.

Document Overview

Document Title: Antithrombotic Therapy In Neonates And Children

Authoring Society: American College of Chest Physicians

Document Publication Date: Feb 1, 2012

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: journal.chestnet.org/article/S0012-3692(12)60137-8/fulltext

Source Citation: DOI: https://doi.org/10.1378/chest.11-2308

Document Scope, Criteria, and Use Cases

Document Objectives: Neonates and children differ from adults in physiology, pharmacologic responses to drugs, epidemiology, and long-term consequences of thrombosis. This guideline addresses optimal strategies for the management of thrombosis in neonates and children.

Scope: Assessment and Screening, Management, Prevention, Treatment

Diseases/Conditions (MeSH)

D056824 - Upper Extremity Deep Vein Thrombosis

D013923 - Thromboembolism

D010372 - Pediatrics

D000925 - Anticoagulants

D054556 - Venous Thromboembolism

D016769 - Embolism and Thrombosis

D054556 - Venous Thromboembolism

D000925 - Anticoagulants

D010372 - Pediatrics

D013923 - Thromboembolism

D056824 - Upper Extremity Deep Vein Thrombosis

D016769 - Embolism and Thrombosis

Keywords: Antithrombotic Agents, Venous Thromboembolism, anticoagulation, deep vein thrombosis, deep venous thrombosis, heparin, thromboembolism

Target Patient Population: Neonates and children with thrombosis risk

Inclusion Criteria: Child, Infant

Health Care Settings: Ambulatory, Childcare Center, Emergency Care, Hospital, Outpatient, School

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 766

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Antithrombotic Therapy In Neonates And Children

Recommendations

Antithrombotic Therapy in Pediatric Patients

Heparin in Neonates and Children

LMWH in Neonates and Children

VKAs in Neonates and Children

Aspirin

Recommendations for Antithrombotic Therapy in Specific Clinical Situations

VTE in Neonates

Renal Vein Thrombosis in Neonates

CVAD Prophylaxis in Neonates

For neonates with CVADs,

Thromboprophylaxis for Blalock-Taussig Shunts and Modifi ed Blalock-Taussig Shunts

Therapy for Femoral Artery Thrombosis in Neonates and Children

For neonates and children with acute femoral artery thrombosis,

Prophylaxis for Peripheral Arterial Catheters in Neonates and Children

Therapy for Peripheral Artery Thrombosis Secondary to Peripheral Artery Catheters in Neonates and Children

Prophylaxis of Umbilical Arterial Catheters in Neonates

Prophylaxis for Cardiac Catheterization in Neonates and Children

For neonates and children requiring CC via an artery

Cerebral Sinovenous Thrombosis in Neonates

Arterial Ischemic Stroke in Neonates

Neonates With Purpura Fulminans

For neonates with homozygous protein C deficiency, after initial stabilization,

DVT and PE in Children

Thrombolysis in Pediatric Patients With DVT

Thrombectomy and IVC Filter Use in Pediatric Patients With DVT

DVT in Children With Cancer

Children With Antiphospholipid Antibodies and DVT

Children With DVT and Positive Inherited Thrombophilia Testing

Children With VTE and Structurally Abnormally Venous Systems

Children With Right Atrial Thrombosis

Children With CVADs

Glenn Procedure or Bilateral Cavopulmonary Shunt

Fontan Surgery

Endovascular Stents

Dilated Cardiomyopathy

Primary Pulmonary Hypertension

Biologic and Mechanical Prosthetic Heart Valves

Primary Prophylaxis for Venous Access Related to Hemodialysis

Use of UFH or LMWH During Hemodialysis

Kawasaki Disease

CSVT in Children

AIS in Children

Embolic Stroke

Dissection

Cerebral Vasculopathies

Moyamoya Disease

Grading Recommendations

Document Overview

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology

For neonates
with homozygous protein C deficiency, after initial stabilization,