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Lookup NU author(s): Dr Tina Biss
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
© 2025 The American Society of HematologyWe conducted this systematic review to evaluate outcomes of thrombolysis followed by anticoagulation vs anticoagulation alone in pediatric patients with venous thromboembolism (VTE). This systematic review addresses mortality, VTE resolution, recurrence, bleeding, and organ-specific outcomes in 5 PICO (population, intervention, comparison, outcomes) questions on thrombolysis across pulmonary embolism (PE), extremity deep vein thrombosis (DVT), right atrial thrombosis (RAT), cerebral sinus venous thrombosis (CSVT), and renal vein thrombosis (RVT). Meta-analysis reported risk ratios or differences (95% confidence intervals [CIs]), and absolute effects per 1000 patients. Certainty of evidence was assessed using GRADE (Grading of recommendation, assessment, Development, and Evaluation) guidelines. Thirteen nonrandomized studies were included and no randomized clinical trials addressed these questions. Thrombolysis might be associated with a higher risk of major bleeding, clinically relevant nonmajor bleeding, or unspecified bleeding with risk differences of 0.09 (95% CI, −0.06 to 0.23), 0.06 (95% CI, −0.11 to 0.22), and 0.09 (95% CI, −0.04 to 0.23), respectively. In PE with hemodynamic compromise, thrombolysis might be associated with a lower risk of mortality but conclusions on PE progression were uncertain in submassive PE. In DVT, thrombolysis may have little to no effect on mortality or thrombus resolution but might be associated with lower risk of postthrombotic syndrome. In RAT, thrombolysis might have little to no effect on thrombus resolution but a higher risk of major bleeding and mortality. For CSVT and RVT, the evidence was very limited. These findings were based on very-low-certainty evidence because of confounding and imprecision from small sample sizes. This systematic review highlights key challenges in developing recommendations for thrombolysis in children with VTE.
Author(s): Kawtharany H, Azzam M, Alkhader A, Betensky M, Hamarsha Q, Abou Zeid HK, Mansour R, Tabak C, Patel P, Baghdadi SL, Bercovitz RS, Bhat R, Biss T, Branchford BR, Brandao LR, Chan AKC, Faustino EVS, Jaffray J, Jones S, Kerlin BA, Kucine N, Kumar R, Male C, Pelland-Marcotte M-C, Raffini L, Raulji CM, Sartain SE, Takemoto CM, Tarango C, van Ommen CH, Velez MC, Vesely SK, Wiernikowski J, Williams S, Wilson HP, Woods G, Zia A, Monagle P, Mustafa RA
Publication type: Review
Publication status: Published
Journal: Blood Advances
Year: 2025
Volume: 9
Issue: 21
Pages: 5512-5527
Print publication date: 11/11/2025
Online publication date: 25/06/2025
Acceptance date: 26/05/2025
ISSN (print): 2473-9529
ISSN (electronic): 2473-9537
Publisher: American Society of Hematology
URL: https://doi.org/10.1182/bloodadvances.2025017058
DOI: 10.1182/bloodadvances.2025017058
PubMed id: 40561511
