Pediatric Thrombosis Program


The Pediatric Thrombosis Program at Johns Hopkins All Children’s Hospital in St. Petersburg, FL combines the expertise of Johns Hopkins All Children’s Hospital and Johns Hopkins Medicine to help children who have developed a blood clot in the veins (venous thrombosis) or arteries (arterial thrombosis). The program extends from inpatient to outpatient care, consultation, and access to the latest research developments in treatment via leadership and participation in clinical trials.Pediatric Thrombosis Page Illustration

The program is directed by Dr. Neil Goldenberg, who was recruited by Johns Hopkins All Children's Hospital and Johns Hopkins University in 2012 from one of the top pediatric blood clotting programs internationally, the Mountain States Regional Hemophilia and Thrombosis Center at Children’s Hospital Colorado, to lead the pediatric thrombosis programs at Johns Hopkins All Children's Hospital and the Johns Hopkins Children’s Center in Baltimore. The physician team also includes Dr. Irmel Ayala, who has led the Johns Hopkins All Children’s bleeding and clotting disorder clinics at the main hospital in St. Petersburg and the subspecialty clinic in Tampa for over a decade. The Johns Hopkins All Children's Hospital program provides a variety of services for pediatric thrombosis patients and their families in a comprehensive, multidisciplinary setting.

Need more information about the Pediatric Thrombosis Program at Johns Hopkins All Children's Hospital? Call (727) 767-4176. 

How are Blood Clots Treated in Children?

Reports have indicated that the rate of thrombosis in U.S. children has dramatically increased in recent years. While thrombosis still occurs less commonly in children than adults, the consequences of thrombosis are especially important in the young patient, whose body is still developing, and whose current/future ability to engage in a high level of physical activity (including athletics) is important medically, developmentally, and socially. It is important to realize that, even though clots often occur in children who have other underlying illnesses, the need for expert management of the blood clot and future risks should not be overlooked. 

The evaluation and treatment of children with thrombosis includes: radiologic imaging to evaluate the extent of the clot and its impact on blood flow (using Doppler ultrasound, CT, or MRI scan, depending on the location and extent of clot); specialized laboratory testing of a child’s blood clotting system; administration of blood thinner medication; follow-up laboratory testing and radiologic imaging to monitor the effects of treatment; decision-making on duration of treatment; and education and guidance on measures to prevent further blood clots after treatment is complete (including future situations in which temporary use of blood thinners may be recommended). All of these components to the best care of patients with thrombosis have unique aspects in children that require a devoted team of pediatric experts in blood clotting and related specialties.  

Why choose the Pediatric Thrombosis Program at Johns Hopkins All Children's Hospital? 

The multidisciplinary thrombosis team at Johns Hopkins All Children's is focused solely on treating infants, children and teens who have developed a blood clot in the veins or arteries. It also provides evaluation of infants, children, and teens who have a family history of blood clots before 50 years of age, and therefore may be at risk for developing young-onset blood clots themselves. Our pediatric thrombosis doctors have devoted their careers to caring for children who experience a blood clot and strive to provide the best possible outcomes for their patients. 

Because of the rarity of thrombosis in children, few physicians have extensive experience in treating this problem and preventing short-term and long-term consequences, including: bleeding complications of blood thinners; persistent blockage in blood flow, despite a routine course of treatment with blood thinner medication; the development of second blood clots; and damage to blood vessels, caused by thrombosis. Drs. Goldenberg and Ayala have a combined experience of managing over 1,000 pediatric thrombosis patients in the past 10 years. This experience, combined with their involvement in the latest national/international guidelines and clinical research studies, has allowed them to determine soon after the onset of thrombosis whether a child is at high versus low risk for the potential long-term complications described above, and to develop an individualized treatment and follow-up plan for each patient--in order to achieve the best outcomes for each infant, child, and teen. 

Why is a multidisciplinary team of experts so important in the care of children with thrombosis? 

Thrombosis in children can occur in the veins or arteries of the limbs, brain, lungs, heart, liver or kidneys, among other vital areas of the body. Optimal care of children with thrombosis therefore can require expertise not only from a pediatric hematologist who specializes in blood clots, but from a variety of pediatric specialties, including hematology, radiology, clinical coagulation laboratory, neurology, pulmonary medicine, cardiology, anticoagulant pharmacy, and others. 

In the inpatient setting (when children are first hospitalized with thrombosis), our multidisciplinary care team consists of:

  • Pediatric intensive care physicians and nurses
  • Pediatric hematologists
  • Pediatric radiologists
  • Pediatric anesthesiologists
  • Pharmacists
  • Child life specialists
  • Social workers
  • Discharge planners
  • Research personnel
  • and other specialists pertinent to the individual child’s condition and needs

In the outpatient setting, our multidisciplinary clinic involves:

  • Drs. Goldenberg and Ayala as pediatric hematologists with specialized expertise in thrombosis
  • An anticoagulant (“blood thinner” medication) pharmacist
  • A pediatric thrombosis nurse
  • Research personnel
  • And coordinated visits with other subspecialists as appropriate to organ systems affected by the blood clot and any underlying chronic medical conditions
    For example:
    • Pediatric cardiologists, for children with congenital heart disease who have developed blood clots;
    • Pediatric neurologists, for children with blood clots in the cerebral venous system;
    • Pediatric oncologists, for children who have developed blood clots while undergoing treatment for cancer.
  • This includes an expert pediatric physician-pharmacist team approach to outpatient dose-adjustment and monitoring of warfarin (Coumadin) in teens and younger children, with options for INR testing at Johns Hopkins All Children's or a variety of outpatient lab facilities, and in either case with direct oversight, results review, decision-making, and patient/primary care provider communication by the pediatric physician-pharmacist Coumadin team. 

Specific Conditions Treated

  • Thrombosis of the deep veins (DVT) of the arms, legs, pelvis, or upper chest
  • Pulmonary embolism
  • Cerebral sinovenous thrombosis
  • Renal vein thrombosis
  • Hepatic vein or portal vein thrombosis
  • Jugular vein thrombosis, including Lemierre's syndrome
  • Vena caval thrombosis
  • Family history of thrombosis before 50 years of age
  • Known inherited trait or acquired condition causing increased risk of thrombosis
  • Protein C, Protein S, and Antithrombin deficiencies
  • Factor V Leiden and Prothrombin (factor II) variants
  • Antiphospholipid antibodies and antiphospholipid antibody syndrome
  • Elevated lipoprotein(a)

Services Offered

  • Hematological evaluation
  • Hypercoagulability (thrombophilia) testing and interpretation
  • Radiologic evaluation and interpretation: Doppler ultrasound, Magnetic resonance (MR) venography (MRV), MR arteriography (MRA), Computed tomography (CT) with venography (CTV), CT with arteriography (CTA), Conventional venography
  • Antithrombotic/anticoagulant ("blood thinner") medication prescription
  • Anticoagulant medication monitoring (including laboratory testing and warfarin dose-adjustment)
  • Thrombolytic ("clot buster") therapies
  • Chronic venous insufficiency (post-thrombotic syndrome) evaluation
  • Preventive medicine
  • Patient/family education
  • Second opinions
  • Local, national, and international research (including clinical trials)


Need more information about the Pediatric Thrombosis Program at Johns Hopkins All Children's Hospital? Call (727) 767-4176.