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Because of their heart condition, the surgeries they undergo, and the medications they need, children with congenital or acquired heart disease are at risk of blood clots (thrombosis) and uncontrolled bleeding. They face unique health challenges and need specialized care.

The Cardiac Antithrombosis Management Program provides the comprehensive care these children need. We don’t just treat bleeding issues; we prevent them. Our program is led by pediatric cardiologists who specialize in heart disease and cardio-hematology (blood and clotting). This specialty recognizes that heart and blood health go hand in hand. We bring together deep expertise in both fields to create precise personalized plans for each child. We prevent complications from clotting and uncontrolled bleeding, provide resources, and fully support children and their families so they can have healthy and active lives.

How will we care for your child?

If your child is at Boston Children’s Benderson Family Heart Center for a procedure, each day members of our team — a cardiologist, nurse practitioner, and pharmacist — will visit their bedside to review how they are responding to their medication. We will also talk to your family and review your child’s medication plan and answer any questions.

When your child is home, we continue to manage their medication and well-being. For example, we help families work with their insurance provider to receive an international normalized ratio (INR) monitor so they can keep track of their child’s response to warfarin.

If your child needs blood thinners (anticoagulants) for the long term, we will create and closely follow through with a detailed care management plan that meets them where they are. We share advice, strategies, and resources. Our team is always available to help your child and family.

Our patients have widely different lifestyles: from active toddlers to competitive teenage athletes. We believe your child deserves the same: a heart that works properly, blood that flows safely, and a life full of play, possibility, and peace of mind.

Why are heart patients at risk for clotting and bleeding?

  • Abnormal blood flow: Congenital heart defects (CHDs) or an abnormal heart structure can cause blood to flow abnormally or slowly, which can lead to blood clotting. For example, children who have coronary artery disease or the rare arrhythmia known as atrial fibrillation (AFib) are at risk of clotting.
  • Heart surgery complications: Children who have heart surgery need to take blood thinners to thin their blood and prevent it from clotting during an operation. The same medications also increase the risk of bleeding, especially after surgery. Managing the balance of when a child should start and stop anticoagulants is delicate and requires an expert’s timing and precision.
  • Medical devices: Many heart patients have a long-term risk of clotting because they rely on cardiac stents, pacemakers, and other implanted medical devices. Blood clots can form on devices because they are not natural to the human body.

What kind of blood thinners will my child need?

For decades, children with heart disease were treated with medications like heparin, enoxaparin (Lovenox), or warfarin (Coumadin). While effective, these medications come with challenges such as the need to frequently monitor blood, dietary restrictions, needle injections, and the high risk of bleeding. Our program is leading the way in offering safer, more effective options. They include:

  • Direct thrombin inhibitors (DTIs): DTIs are safer for children who have ventricular assist devices (VADs), where the risk of stroke for those patients was once very high. DTIs are more predictable and precise than older medications, and they’ve helped reduce stroke rates in children who have VADs from 30–50 percent to under 10 percent.
  • Direct oral anticoagulants (DOACs): DOACs are easier to take; they don’t require injections or food restrictions. They also cause fewer bleeding complications than warfarin or enoxaparin. The personalized dosing strategies our team create for children make DOACs even more effective for children. Our team has safely treated more than 1,000 children with the DOAC apixaban, outcomes that are unsurpassed in pediatric cardiology care.