title: New developments in pediatric venous thromboembolism and anticoagulation, including the target-specific oral anticoagulants.
abstract: OBJECTIVE
  Pediatric venous thromboembolism (VTE) can affect children of all ages, requiring considerable pharmacologic intervention and is often associated with significant morbidity. Current research efforts are directed toward the development of risk-stratified VTE prevention strategies employing pharmacologic thromboprophylaxis, the optimization of conventional anticoagulation, and the investigation of the safety and efficacy of target-specific oral anticoagulants (TSOACs) in children.
  
  
  RESULTS
  Recent research has considerably improved the understanding of risk factors of hospital-acquired VTE and how these factors may be employed in risk-stratified paradigms for VTE prevention in children. Additional insight has been gained in the optimization of conventional anticoagulants in special populations such as neonates and children with inflammatory conditions, and in improving the overall safety and compliance with periprocedural anticoagulation and the use of home International Normalized Ratio monitoring. Furthermore, the use of TSOACs has been described in children and is the focus of numerous ongoing clinical trials that are evaluating the safety and efficacy of these agents in children with VTE.
  
  
  CONCLUSIONS
  Identification of hospital-acquired VTE risk factors may inform pediatric VTE prevention strategies. Although initial use of TSOACs may be promising, investigation of safety and efficacy in children is still underway.
authors.affiliation: aDepartment of Pediatrics, Billings Clinic, Billings, Montana bDepartment of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia cJHM Pediatric Thrombosis Program, All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, Florida dJohns Hopkins Children's Center and Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA *Coutney A. Lyle and Robert F. Sidonio contributed equally to the writing of this article.
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Lyle
authors.forename: Robert F
authors.initials: RF
authors.lastname: Sidonio
authors.forename: Neil A
authors.initials: NA
authors.lastname: Goldenberg
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000367:Age Factors; D000925:Anticoagulants / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D006331:Heart Diseases / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D055118:Medication Adherence; D009369:Neoplasms / Q000628:therapy*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D000925:Anticoagulants