The hemostatic system in neonates and infants with congenital heart disease is distinct as a result of developmental and disease-specific factors, necessitating population-specific periprocedural evaluation and antithrombotic management. Ongoing practice variation reflects limited evidence and highlights the need for structured guidance and further study.

To develop a more unified management strategy for periprocedural antithrombotic testing and therapy in this vulnerable population, a group of experts (cardiac surgeons, cardiologists, interventionalist, hematologists, intensivists, and pharmacologists) commissioned by the American Association for Thoracic Surgery was convened to define the basic differences in the hemostatic systems of neonates and infants compared with older children and adults and develop a framework for periprocedural antithrombotic management in neonates and infants undergoing congenital cardiac interventions using the modified Delphi methodology.

Consensus was reached on all 34 statements and related figures and tables. These provide information specific to neonates and infants with congenital heart disease on the coagulation cascade; testing for congenital, acquired, and therapy-related abnormalities in the hemostatic system; and commonly used antithrombotic (anticoagulant and antiplatelet) agents and their monitoring. Recommendations were made on pre-, intra-, and postprocedural antithrombotic management, including procedure and device-specific recommendations both in the short and long term.

The hemostatic system in neonates and infants with congenital heart disease is distinct from that of older children and adults and warrants focused periprocedural evaluation and therapy. These recommendations guide understanding of the complex interactions during antithrombotic management in this patient population during cardiac surgical and catheter-based interventions.