# European thromboprophylaxis practice amongst paediatric cardiology units

## TL;DR

This study shows that European doctors use different approaches to prevent blood clots in children with heart disease, highlighting the need for better guidelines.

## Contribution

The study reveals significant variation in thromboprophylaxis practices across Europe and emphasizes the need for updated, evidence-based guidelines.

## Key findings

- There is significant variation in thromboprophylaxis practices among European pediatric cardiology units.
- Differences exist in indications, medications, and treatment duration for various patient groups.
- The study highlights the need for evidence-based guidelines to standardize care.

## Abstract

Children with congenital and acquired heart disease have an increased risk of thromboembolic events. There is a paucity of evidence on the optimal approach to thromboprophylaxis for this population, and the introduction of direct oral anticoagulants in recent years has led to significant variation in clinical practice. The aim of the study was to describe current practice in thromboprophylaxis prescribing amongst European Paediatric Cardiology units managing paediatric and congenital heart disease. A structured and approved online survey (SurveyMonkey.com) was developed for distribution to AEPC affiliated paediatric cardiology centres in Europe. Responses were received from 30 participants working in 27 Paediatric Cardiology centres across Europe. There is significant variation between participants in the approach to thromboprophylaxis in different patient cohorts, including functional single ventricle patients, post-cardiac catheterisation intervention/electrophysiology study, post-prosthetic valve insertion, cardiomyopathy/heart failure, and infective endocarditis. Differences were seen in the indications for thromboprophylaxis, as well as the agents used and the duration of treatment.

Conclusion: There is significant variation in practice amongst participants in Europe. Further studies are required in order to develop evidence-based guidelines for clinical practice.
What is Known:• Children with congenital and acquired heart disease have increased predisposition to thrombosis after specific surgeries and interventions.• International guidelines exist for the management of antiplatelet and anticoagulation agents in children with congenital and acquired heart disease.What is New:• This study outlines the variation in practice amongst clinicians in Europe in the indications for thromboprophylaxis, medications used and duration of treatment for both congenital and acquired heart disease in paediatric patients.• This study highlights the need for up-to-date, evidence-based thromboprophylaxis guidelines for this patient population, including recommendations on direct oral anticoagulant use.

What is Known:

• Children with congenital and acquired heart disease have increased predisposition to thrombosis after specific surgeries and interventions.

• International guidelines exist for the management of antiplatelet and anticoagulation agents in children with congenital and acquired heart disease.

What is New:

• This study outlines the variation in practice amongst clinicians in Europe in the indications for thromboprophylaxis, medications used and duration of treatment for both congenital and acquired heart disease in paediatric patients.

• This study highlights the need for up-to-date, evidence-based thromboprophylaxis guidelines for this patient population, including recommendations on direct oral anticoagulant use.

The online version contains supplementary material available at 10.1007/s00431-025-06351-x.