Today, we are outlining key recommendations from the 2026 American Society of Hematology (ASH) and International Society on Thrombosis and Haemostasis (ISTH) guideline, Anticoagulant Prophylaxis of Pediatric Patients at Risk of Venous Thromboembolism (VTE). The guideline was developed to address the lack of consensus on pediatric anticoagulant prophylaxis strategies and to support clinical decision-making regarding those strategies. As a result, the guideline panel developed 12 recommendations for a range of pediatric subgroups.  

Below is a summary of the recommendations from the ASH/ISTH guideline. Refer to the full-text version for the full recommendations. 

Key Elements from the 2026 ASH/ISTH Guideline

Pediatric Patients with Cancer

For pediatric patients with leukemia or lymphoblastic lymphoma, the guideline suggests either  anticoagulant prophylaxis or no anticoagulant prophylaxis. The guideline also suggests no antithrombin supplementation. For pediatric patients with solid tumors, the guideline suggests no anticoagulant prophylaxis. 

Total Parenteral Nutrition Prophylaxis

For pediatric patients receiving total parental nutrition (TPN) more than 60 days, the guideline suggests anticoagulant prophylaxis. 

Central Venous Access Device

For pediatric patients with a short term central venous access device (CVAD), the guideline suggests no anticoagulant prophylaxis. For pediatric patients with medium/long term CVAD in the absence of TPN or cancer, the guideline suggests no anticoagulant prophylaxis. 

Antiphospholipid Antibodies

For pediatric patients with antiphospholipid antibody syndrome, the guideline suggests secondary anticoagulant prophylaxis. For patients with persistently positive antiphospholipid antibodies, the guideline suggests no primary anticoagulant prophylaxis.

Trauma Patients

For pediatric patients with trauma, the guideline suggests no anticoagulant prophylaxis.

Hospitalized Patients

For hospitalized pediatric patients, the guideline suggests no anticoagulant prophylaxis. 

Critically Ill Patients

For critically ill pediatric patients with or without a CVAD, the guideline suggests no anticoagulant prophylaxis. 

Surgery Patients

For children undergoing noncardiac surgery, the guideline suggests no anticoagulant prophylaxis. 

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