OBJECTIVE To explore the research progress in the treatment and prevention of venous thromboembolism in children with renal insufficiency, and to provide a reference for clinical practice.

METHODS A comprehensive literature search was conducted in databases including CNKI, Wanfang Data, and PubMed using the keywords “renal insufficiency” “children” “venous thromboembolism” “anticoagulant drugs” and their English equivalents. The search covered articles published from September 2015 to September 2025. The retrieved literature was systematically analyzed to summarize the research progress in anticoagulant therapy for venous thromboembolism in children with renal insufficiency.

RESULTS A total of 89 relevant articles were identified, among which 40 were eligible for inclusion. The risk factors for thrombosis in children with renal insufficiency were unique. In addition to the severity of renal insufficiency, individual characteristics of the children and disease-related factors might also affect the pharmacokinetics and pharmacodynamics of anticoagulant drugs. Among the anticoagulants available for pediatric use, unfractionated heparin and argatroban did not require dosage adjustment in patients with renal insufficiency, but they had to be administered intravenously, which limited their convenience. For subcutaneous low-molecular-weight heparins, enoxaparin had the most abundant clinical data in children, yet its dosage should be determined based on the patients’ renal function status. Warfarin, an oral anticoagulant, did not need dosage adjustment in the setting of renal insufficiency, but it required frequent laboratory monitoring and was associated with numerous drug interactions. The oral direct oral anticoagulants rivaroxaban and dabigatran had sufficient pediatric data and necessitated dosage adjustment according to renal function; notably, both were available as oral suspensions, which conferred a relative advantage in improving medication adherence in children.

CONCLUSION Each anticoagulant has unique characteristics and precautions for use in children with renal insufficiency. When selecting and adjusting the dosage of anticoagulants, it is essential to fully consider the children’s renal function status, the pharmacological properties of the drugs, and disease-related factors, so as to formulate the optimal anticoagulant regimen.