The International Society on Thrombosis and Hemostasis has released guidance on identifying at-risk patients and preventing venous thromboembolism in pediatric cancer. Among the recommendations:

• Perform comprehensive risk assessment on each pediatric cancer patient at the initiation of cancer therapy.
• Do not administer routine primary thromboprophylaxis in pediatric cancer patients without a history of prior thrombosis.
• Administer thromboprophylaxis in pediatric cancer patients with prior thrombosis who are continuing to receive intensive therapy, as long as there are no anticoagulation contraindications.
• Consider thromboprophylaxis on a case-by-case basis for pediatric cancer patients with no history of VTE, but with significant combinations of risk factors, including central venous catheters, asparaginase therapy, obesity, adolescence, hormonal contraceptives, or hospitalization for surgery.