New Consensus Guidance Addresses Antithrombotic Management in Infants With Congenital Heart Disease

New AATS consensus recommendations aim to reduce variation in antithrombotic testing, treatment, and monitoring for neonates and infants undergoing cardiac interventions.

Antithrombotic management around cardiac procedures can be particularly challenging in neonates and infants, whose hemostatic systems differ from those of older children and adults. Limited population-specific evidence has contributed to substantial variation in practice across centers.

A new expert consensus statement from the American Association for Thoracic Surgery (AATS), published in The Journal of Thoracic and Cardiovascular Surgery, provides population-specific guidance for antithrombotic evaluation, treatment, and monitoring in neonates and infants undergoing cardiac surgical and catheter-based interventions.

Nationwide Children’s was represented on the multidisciplinary panel by Can Yerebakan, MD, PhD, chief of the Department of Cardiothoracic Surgery who served as co-chair of the consensus group, and Amee M. Bigelow, MD, medical director of the Cardiothoracic Intensive Care Unit. The Heart Center at Nationwide Children’s performed 1,914 operations from 2022 through 2025, including more than 540 in 2025 alone. During that four-year period, 43% of patients were neonates and infants aged 1 year or younger.

“Outcomes in congenital heart surgery have improved tremendously, but anticoagulation management in our smallest patients remains a challenge,” says Dr. Yerebakan. “The coagulation system in babies is distinct, and evidence from older children and adults cannot simply be translated to neonates and infants.”

Commissioned by the AATS, experts from 10 centers used a modified Delphi process to develop the statement. Consensus was reached on all 34 statements, which address developmental differences in the hemostatic system; testing for congenital, acquired, and treatment-related abnormalities; commonly used anticoagulant and antiplatelet therapies and their monitoring; and antithrombotic management before, during, and after cardiac interventions.

“Rather than one recommendation being more important than another, the strength of the document is that it looks across the entire course of care,” Dr. Yerebakan says. “It provides a framework from the postnatal period through medical, interventional, and surgical management.”

The authors emphasize that the statement is consensus-based clinical guidance rather than a rigid treatment standard. Although the panel conducted an extensive review of the available literature, important evidence gaps remain.

“These recommendations are not dogma,” Dr. Yerebakan says. “They give centers something to rely on when they face difficult management decisions, while also helping us identify the questions that still need prospective study.”

Dr. Yerebakan says the group hopes the statement will help reduce practice variation and bring centers toward a more unified approach. Future efforts are expected to address antithrombotic management during ventricular assist device support and in older pediatric patients.

Reference

Nathan M, Kiskaddon AL, Emani S, Bigelow AM, Callahan RM, Cleveland JD, Federman M, Ma M, McMullan DM, Mir A, Branstetter J, VanderPluym C, Yerebakan C. 2026 American Association for Thoracic Surgery (AATS) expert consensus statement: Antithrombotic management of neonates/infants undergoing cardiac interventions. Journal of Thoracic and Cardiovascular Surgery. 2026 Sep;172(3):618-662.e7. doi: 10.1016/j.jtcvs.2026.03.617.

Image credit: Nationwide Children’s (portraits); Adobe Stock (header)