Summary of 2018 ASH treatment recommendations for acute pediatric VTE2
| VTE description . | Treatment recommendation . | Comments . |
|---|---|---|
| Symptomatic DVT or PE | • Anticoagulation | Observation may be necessary or reasonable for premature neonates or critically ill children at high risk of bleeding |
| Provoked VTE: treat ≤3 mo (if provoking factor is resolved) | ||
| Unprovoked VTE: treat 6-12 mo; consider longer duration based on patient’s preferences | ||
| • Avoid thrombolysis (unless life- or limb-threatening) | ||
| • Avoid IVC filter (unless absolute contraindication to anticoagulation) | ||
| Asymptomatic DVT or PE | • Anticoagulation or observation | Natural history is not well known; decision is likely to vary based on thrombus location and patient |
| Massive PE with hemodynamic compromise | • Thrombolysis followed by anticoagulation | |
| Submassive PE (no hemodynamic instability) | • Anticoagulation alone | |
| CVAD thrombosis | • See Figure 1 | |
| RVT | • Unilateral: anticoagulation alone | |
| • Bilateral: consider thrombolysis for bilateral RVT (life-threatening) | ||
| Portal vein thrombosis | • Occlusive: anticoagulation | |
| • Nonocclusive: observation (close radiologic follow-up) | ||
| Cerebral sinovenous thrombosis | • Anticoagulation | Decision in patients with intracranial hemorrhage needs to be individualized, but some patients may benefit from anticoagulation |
| VTE description . | Treatment recommendation . | Comments . |
|---|---|---|
| Symptomatic DVT or PE | • Anticoagulation | Observation may be necessary or reasonable for premature neonates or critically ill children at high risk of bleeding |
| Provoked VTE: treat ≤3 mo (if provoking factor is resolved) | ||
| Unprovoked VTE: treat 6-12 mo; consider longer duration based on patient’s preferences | ||
| • Avoid thrombolysis (unless life- or limb-threatening) | ||
| • Avoid IVC filter (unless absolute contraindication to anticoagulation) | ||
| Asymptomatic DVT or PE | • Anticoagulation or observation | Natural history is not well known; decision is likely to vary based on thrombus location and patient |
| Massive PE with hemodynamic compromise | • Thrombolysis followed by anticoagulation | |
| Submassive PE (no hemodynamic instability) | • Anticoagulation alone | |
| CVAD thrombosis | • See Figure 1 | |
| RVT | • Unilateral: anticoagulation alone | |
| • Bilateral: consider thrombolysis for bilateral RVT (life-threatening) | ||
| Portal vein thrombosis | • Occlusive: anticoagulation | |
| • Nonocclusive: observation (close radiologic follow-up) | ||
| Cerebral sinovenous thrombosis | • Anticoagulation | Decision in patients with intracranial hemorrhage needs to be individualized, but some patients may benefit from anticoagulation |
DVT, deep vein thrombosis; IVC, inferior vena cava; RVT, renal vein thrombosis.