ESMINT-ESNR-IPSO-SNIS-WFITN guidelines on antiplatelet therapy in pediatric neurointervention: practical recommendations and dosing strategies.

Pediatric neurointerventional procedures are increasingly performed, yet antiplatelet management remains largely empirical or extrapolated from adult practice because of limited pediatric-specific evidence. This guideline provides scenario-based recommendations for antiplatelet therapy in children undergoing neurointerventional procedures; anticoagulant therapy will be addressed separately. Institutional protocols from experienced pediatric neurointerventional specialists were integrated with a comprehensive scoping literature review through an iterative consensus process involving the European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), International Pediatric Stroke Organization (IPSO), Society of NeuroInterventional Surgery (SNIS), and World Federation of Interventional and Therapeutic Neuroradiology (WFITN). Recommendations are organized around common clinical scenarios, including elective and emergency aneurysm treatment and the management of thromboembolic complications. Dosing, administration, and monitoring considerations are provided for aspirin, clopidogrel, prasugrel, ticagrelor, cangrelor, and glycoprotein IIb/IIIa inhibitors, with additional attention to age-dependent pharmacokinetics, renal function, available formulations, and platelet-function testing. These expert-consensus recommendations are intended to support safer and more consistent clinical practice while recognizing the need for individualized clinical judgment and prospective pediatric studies.