{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:52:24Z","timestamp":1791903144041,"version":"4.3.4"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pulm. circ."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    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\u2010world 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\u20132024), comparing characteristics of those who received aspirin or warfarin with those who did not. A survey on real\u2010world 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\u2010treated patients demonstrated higher\u2010risk features as evidenced by use of PH\u2010targeted triple therapy (aspirin vs. no aspirin: 22% vs. 9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01; warfarin vs. no warfarin: 31% vs. 10%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01) and higher mortality over a median follow\u2010up of 3.2 years (aspirin vs. no aspirin: 14% vs. 9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008; warfarin vs. no warfarin: 19% vs. 9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001). Center\u2010specific 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\u2010risk patients varied considerably. Antithrombotic therapy is used infrequently in pediatric PH and primarily reserved for high\u2010risk patients, with significant variation across centers. These findings highlight the need for further research to define which patients may benefit and guide evidence\u2010based practice.\n                  <\/jats:p>","DOI":"10.1002\/pul2.70418","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:32:26Z","timestamp":1791901946000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antithrombotic Therapy Use in Children With Pulmonary Hypertension"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3948-5933","authenticated-orcid":false,"given":"Meredith J.","family":"O'Neil","sequence":"first","affiliation":[{"name":"The Heart Institute, Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Division of Pharmacy Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8055-768X","authenticated-orcid":false,"given":"Lynn A.","family":"Sleeper","sequence":"additional","affiliation":[{"name":"Department of Cardiology Boston Children's Hospital Boston Massachusetts USA"},{"name":"Department of Pediatrics Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4422-3065","authenticated-orcid":false,"given":"Nidhy P.","family":"Varghese","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pulmonology Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8634-1399","authenticated-orcid":false,"given":"Paul J.","family":"Critser","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1709-9022","authenticated-orcid":false,"given":"Eric D.","family":"Austin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Allergy Immunology and Pulmonary Medicine, Vanderbilt Children's Hospital Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2354-5447","authenticated-orcid":false,"given":"Catherine M.","family":"Avitabile","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Pennsylvania Perelman School of Medicine; Division of Cardiology, Children's Hospital of Philadelphia Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Bates","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics University of Alberta Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4849-214X","authenticated-orcid":false,"given":"Erika B.","family":"Rosenzweig","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics Maria Fareri Children's Hospital of Westchester Medical Center Health Network and New York Medical College Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5504-5471","authenticated-orcid":false,"given":"Carly E.","family":"Byrd","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9299-1926","authenticated-orcid":false,"given":"Patrick D.","family":"Evers","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics Oregon Health and Science University Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie S.","family":"Handler","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology) Medical College of Wisconsin Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7483-2825","authenticated-orcid":false,"given":"Rachel K.","family":"Hopper","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology) Stanford University School of Medicine Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3343-7502","authenticated-orcid":false,"given":"Emma O.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Heart Center, Seattle Children's Hospital Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0743-8470","authenticated-orcid":false,"given":"Roberta L.","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology University of California San Francisco CA San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5733-6096","authenticated-orcid":false,"given":"Usha S.","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Columbia University Irving Medical Center, Children's Hospital of New York Presbyterian New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minmin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Boston Children's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Maclean","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Cardiology University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7602-7512","authenticated-orcid":false,"given":"Raysa","family":"Morales\u2010Demori","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Critical Care Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0291-9630","authenticated-orcid":false,"given":"Mary P.","family":"Mullen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Boston Children's Hospital Boston Massachusetts USA"},{"name":"Department of Pediatrics Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0091-2892","authenticated-orcid":false,"given":"Meredith","family":"Riker","sequence":"additional","affiliation":[{"name":"Heart Center, Seattle Children's Hospital Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4580-9965","authenticated-orcid":false,"given":"Rachel T.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Cardiology Monroe Carrell Jr. Children's Hospital at Vanderbilt Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4571-4977","authenticated-orcid":false,"given":"Delphine","family":"Yung","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Cardiology University of Washington School of Medicine Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2227-6265","authenticated-orcid":false,"given":"Benjamin S.","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Cardiology University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Pediatric Pulmonary Hypertension Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"4","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01325-2024","article-title":"Treatment Algorithm for Pulmonary Arterial Hypertension","volume":"64","author":"Chin K. M.","year":"2024","journal-title":"European Respiratory Journal"},{"issue":"4","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01345-2024","article-title":"Embracing the Challenges of Neonatal and Paediatric Pulmonary Hypertension","volume":"64","author":"Ivy D.","year":"2024","journal-title":"European Respiratory Journal"},{"issue":"12","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1016\/j.healun.2022.08.019","article-title":"Anticoagulation in Pulmonary Arterial Hypertension \u2010 Association With Mortality, Healthcare Utilization, and Quality of Life: The Pulmonary Hypertension Association Registry (PHAR)","volume":"41","author":"Garry J. D.","year":"2022","journal-title":"Journal of Heart and Lung Transplantation"},{"issue":"13","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.jacc.2025.07.026","article-title":"Association Between Anticoagulant Therapy and Survival in Pulmonary Arterial Hypertension","volume":"86","author":"Bertoletti L.","year":"2025","journal-title":"Journal of the American College of Cardiology"},{"issue":"1","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1161\/CIRCULATIONAHA.113.004526","article-title":"Anticoagulation and Survival in Pulmonary Arterial Hypertension: Results From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)","volume":"129","author":"Olsson K. M.","year":"2014","journal-title":"Circulation"},{"issue":"25","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1161\/CIRCULATIONAHA.115.018435","article-title":"Effect of Warfarin Treatment on Survival of Patients With Pulmonary Arterial Hypertension (PAH) in the Registry to Evaluate Early and Long\u2010Term PAH Disease Management (REVEAL)","volume":"132","author":"Preston I. R.","year":"2015","journal-title":"Circulation"},{"issue":"3","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1177\/2045893217721903","article-title":"Complications Associated With the Use of Oral Anticoagulation in Patients With Pulmonary Arterial Hypertension From Two Referral Centers","volume":"7","author":"Roldan T.","year":"2017","journal-title":"Pulmonary Circulation"},{"key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.thromres.2020.08.024","article-title":"Can Anticoagulants Improve the Survival Rate for Patients With Idiopathic Pulmonary Arterial Hypertension? A Systematic Review and Meta\u2010Analysis","volume":"196","author":"Wang P.","year":"2020","journal-title":"Thrombosis Research"},{"issue":"9","key":"e_1_2_12_10_1","article-title":"Is Anticoagulation Beneficial in Pulmonary Arterial Hypertension?","volume":"11","author":"Khan M. S.","year":"2018","journal-title":"Circulation: Cardiovascular Quality and Outcomes"},{"key":"e_1_2_12_11_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.thromres.2024.109173","article-title":"The Role of Anticoagulation on the Long\u2010Term Survival of Patients With Pulmonary Arterial Hypertension: A Meta\u2010Analysis of 15 Cohort Studies","volume":"243","author":"Chen X.","year":"2024","journal-title":"Thrombosis Research"},{"issue":"38","key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1093\/eurheartj\/ehac237","article-title":"2022 ESC\/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension","volume":"43","author":"Humbert M.","year":"2022","journal-title":"European Heart Journal"},{"issue":"21","key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1161\/CIR.0000000000000329","article-title":"Pediatric Pulmonary Hypertension: Guidelines From the American Heart Association and American Thoracic Society","volume":"132","author":"Abman S. H.","year":"2015","journal-title":"Circulation"},{"issue":"1","key":"e_1_2_12_14_1","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.03337-2020","article-title":"Characterisation of Paediatric Pulmonary Hypertensive Vascular Disease From the PPhNet Registry","volume":"59","author":"Abman S. H.","year":"2022","journal-title":"European Respiratory Journal"},{"key":"e_1_2_12_15_1","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.thromres.2017.10.024","article-title":"Assessment of the Quality of Anticoagulation Management in Patients With Pulmonary Arterial Hypertension","volume":"160","author":"Roldan T.","year":"2017","journal-title":"Thrombosis Research"},{"issue":"4","key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2045894019895451","article-title":"Anticoagulation in Pulmonary Arterial Hypertension: A Decision Analysis","volume":"9","author":"Jose A.","year":"2019","journal-title":"Pulmonary Circulation"},{"issue":"1","key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12887-023-03860-2","article-title":"Quantifying Side Effects and Caregiver Burdens of Pediatric Pulmonary Hypertension Therapies","volume":"23","author":"Nelson E. J.","year":"2023","journal-title":"BMC Pediatrics"},{"issue":"2","key":"e_1_2_12_18_1","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00740-2017","article-title":"Mortality in Pulmonary Arterial Hypertension: Prediction by the 2015 European Pulmonary Hypertension Guidelines Risk Stratification Model","volume":"50","author":"Hoeper M. M.","year":"2017","journal-title":"European Respiratory Journal"},{"issue":"4","key":"e_1_2_12_19_1","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01294-2024","article-title":"Chronic Thromboembolic Pulmonary Disease","volume":"64","author":"Kim N. H.","year":"2024","journal-title":"European Respiratory Journal"},{"key":"e_1_2_12_20_1","doi-asserted-by":"crossref","DOI":"10.1097\/CRD.0000000000000735","article-title":"Safety and Outcomes With Direct Oral Anticoagulants Versus Vitamin\u2010K Antagonists in Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review, Meta\u2010Analysis, and Meta\u2010Regression","author":"Jain H.","year":"2024","journal-title":"Cardiology in Review"},{"issue":"7","key":"e_1_2_12_21_1","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1007\/s11239-024-03021-x","article-title":"The Use of Non\u2010Vitamin K Antagonist Oral Anticoagulants in Chronic Thromboembolic Pulmonary Hypertension: An Updated Meta\u2010Analysis","volume":"57","author":"Wu D.","year":"2024","journal-title":"Journal of Thrombosis and Thrombolysis"},{"issue":"10","key":"e_1_2_12_22_1","doi-asserted-by":"crossref","first-page":"e500","DOI":"10.1016\/S2352-3026(19)30161-9","article-title":"Bodyweight\u2010Adjusted Rivaroxaban for Children With Venous Thromboembolism (EINSTEIN\u2010Jr): Results From Three Multicentre, Single\u2010Arm, Phase 2 Studies","volume":"6","author":"Monagle P.","year":"2019","journal-title":"Lancet Haematology"},{"issue":"1","key":"e_1_2_12_23_1","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1016\/S2352-3026(19)30219-4","article-title":"Rivaroxaban Compared With Standard Anticoagulants for the Treatment of Acute Venous Thromboembolism in Children: A Randomised, Controlled, Phase 3 Trial","volume":"7","author":"Male C.","year":"2020","journal-title":"Lancet Haematology"},{"issue":"5","key":"e_1_2_12_24_1","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/jth.15277","article-title":"Pharmacokinetic Modeling and Simulation Support for Age\u2010 and Weight\u2010Adjusted Dosing of Dabigatran Etexilate in Children With Venous Thromboembolism","volume":"19","author":"R\u00f6shammar D.","year":"2021","journal-title":"Journal of Thrombosis and Haemostasis"},{"issue":"1","key":"e_1_2_12_25_1","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.1016\/S2352-3026(20)30368-9","article-title":"Dabigatran Etexilate for the Treatment of Acute Venous Thromboembolism in Children (Diversity): A Randomised, Controlled, Open\u2010Label, Phase 2b\/3, Non\u2010Inferiority Trial","volume":"8","author":"Halton J.","year":"2021","journal-title":"Lancet Haematol"},{"issue":"24","key":"e_1_2_12_26_1","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.1016\/j.jacc.2022.09.031","article-title":"Edoxaban for Thromboembolism Prevention in Pediatric Patients With Cardiac Disease","volume":"80","author":"Portman M. A.","year":"2022","journal-title":"Journal of the American College of Cardiology"},{"issue":"24","key":"e_1_2_12_27_1","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1016\/j.jacc.2023.10.010","article-title":"Apixaban for Prevention of Thromboembolism in Pediatric Heart Disease","volume":"82","author":"Payne R. M.","year":"2023","journal-title":"Journal of the American College of Cardiology"},{"issue":"22","key":"e_1_2_12_28_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.021765","article-title":"Thromboprophylaxis for Children Post\u2010Fontan Procedure: Insights From the UNIVERSE Study","volume":"10","author":"McCrindle B. W.","year":"2021","journal-title":"Journal of the American Heart Association"}],"container-title":["Pulmonary Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pul2.70418","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pul2.70418","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pul2.70418","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:32:30Z","timestamp":1791901950000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pul2.70418"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":27,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/pul2.70418"],"URL":"https:\/\/doi.org\/10.1002\/pul2.70418","archive":["Portico"],"relation":{},"ISSN":["2045-8940","2045-8940"],"issn-type":[{"value":"2045-8940","type":"print"},{"value":"2045-8940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-04-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70418"}}