Meredith J. O’Neil, Lynn A. Sleeper, Nidhy P. Varghese, Paul J. Critser, Eric D. Austin, Catherine M. Avitabile, Angela Bates, Erika B. Rosenzweig, Carly E. Byrd, Patrick D. Evers, Stephanie S. Handler, Rachel K. Hopper, Emma O. Jackson, Roberta L. Keller, Usha S. Krishnan, Minmin Lu, Jessica Maclean, Raysa Morales‐Demori, Mary P. Mullen, Meredith Riker, Rachel T. Sullivan, Delphine Yung, Benjamin S. Frank, the Pediatric Pulmonary Hypertension Network
Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine. Boston Children’s Hospital and Harvard Medical School. Baylor College of Medicine and Texas Children’s Hospital. Vanderbilt Children’s Hospital (Monroe Carrell Jr. Children’s Hospital). University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia. University of Alberta. Maria Fareri Children’s Hospital of Westchester Medical Center Health Network and New York Medical College. Johns Hopkins University School of Medicine. Oregon Health and Science University. Medical College of Wisconsin. Stanford University School of Medicine. Seattle Children’s Hospital and University of Washington School of Medicine. University of California San Francisco. Columbia University Irving Medical Center and Children’s Hospital of New York Presbyterian. University of Colorado School of Medicine.
United States and Canada
Pulmonary Circulation
Pulm Circ 2026;
DOI: 10.1002/pul2.70418
Abstract
The role of antithrombotic therapy in pulmonary hypertension (PH) remains uncertain, with conflicting adult data and limited pediatric evidence. This study aimed to describe real-world antithrombotic use in pediatric PH utilizing Pediatric Pulmonary Hypertension Network (PPHNet) registry data and a survey of PPHNet centers. We analyzed data of 1,716 patients from the PPHNet registry (2014-2024), comparing characteristics of those who received aspirin or warfarin with those who did not. A survey on real-world antithrombotic use was also distributed to 12 North American PPHNet centers in 2023. Eighteen percent of subjects received aspirin and 7% received warfarin. Patients who received aspirin or warfarin were more likely to have idiopathic/heritable PH. Aspirin or warfarin-treated patients demonstrated higher-risk features as evidenced by use of PH-targeted triple therapy (aspirin vs. no aspirin: 22% vs. 9%, p < 0.01; warfarin vs. no warfarin: 31% vs. 10%; p < 0.01) and higher mortality over a median follow-up of 3.2 years (aspirin vs. no aspirin: 14% vs. 9%, p = 0.008; warfarin vs. no warfarin: 19% vs. 9%, p = 0.001). Center-specific aspirin and warfarin use varied widely. Survey data demonstrated general agreement that antithrombotic therapy was not indicated for patients at lowest risk and probably indicated for patients at highest risk, but management of intermediate-risk patients varied considerably. Antithrombotic therapy is used infrequently in pediatric PH and primarily reserved for high-risk patients, with significant variation across centers. These findings highlight the need for further research to define which patients may benefit and guide evidence-based practice.
Category
Medical Therapy. Efficacy or Lack of Efficacy
Medical Therapy. Adverse Effects or Lack of Adverse Effects
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes