Contemporary management of pediatric venous thrombosis: how does it differ from adult care?

In children, venous thromboembolism is most often provoked-typically by central venous catheters or postoperative states-whereas adults more commonly present with unprovoked or cancer-associated thrombosis. While the use of direct oral anticoagulants is expanding in pediatrics with increasing safety and efficacy data, parenteral anticoagulation with low-molecular-weight heparin and unfractionated heparin remains widely used, particularly in certain clinical situations. Treatment duration also differs: pediatric guidelines support shorter courses for provoked events and emphasize imaging-guided reassessment. This JTH in Clinic article reviewed contemporary pediatric venous thromboembolism management and highlighted key differences from adult practice. The article also emphasized the importance of dedicated pediatric anticoagulation stewardship programs to improve safety, ensure optimal dosing, support transitions to oral agents, and guide treatment duration. Across all age groups, shared decision-making remains essential to delivering high-quality thrombosis care.