Abdul Mannan: Evidence-Based Anticoagulation Strategies for Children With VTE
Abdul Mannan, Consultant Hematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn:
“Most pediatric thrombosis guidelines were written by adults.
Literally. They were extrapolated from adult data. For decades.
That just changed.
The ASH/ISTH 2024 Paediatric VTE Guidelines dropped in Blood Advances (May 2025).
First ever joint guidelines built specifically on paediatric evidence.
And some of it will surprise you:
- For a first provoked DVT in a child?
6 weeks of anticoagulation may be enough.
Not 3 months. Not 6 months. Six. Weeks.
(If the trigger is gone and risk is low)
- DOACs are now endorsed for children.
Rivaroxaban and dabigatran both have age-appropriate approvals.
- Weight-based dosing.
- Oral.
- No INR checks.
Kids don’t have to live on warfarin anymore.
- That CVAD clot you found on imaging?
If the line is working and the child is stable — you probably don’t need to remove it.
Anticoagulate. Keep the line. Reassess.
- Unsuspected PE in a child?
Treat it. Even if they look fine.
Silent doesn’t mean harmless.
The old ‘just use the adult dose and adjust’ era is over.
These guidelines represent real paediatric trial data — Diversity, Kids-DOTT, EINSTEIN-Jr, KIDS-DOTT. Proper evidence. Proper patients.
I built a free interactive clinical reference tool based on these guidelines — all 20 recommendations, evidence summaries, drug dosing tables, and decision support. No login. No paywall.
Bookmark it. Share it with your paediatric colleagues.
What surprises you most — the 6-week duration or DOACs in kids?”
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