There are many limitations with respect to anticoagulants currently used in standard paediatric practice for prophylaxis and treatment of thrombosis: heparin, low molecular-weight heparin, and warfarin. Factors such as pharmacokinetic and dosing variability are further exacerbated by properties of the immature haemostatic system of children. These shortcomings necessitate exploring alternative anticoagulants in the paediatric population. In this review, we discuss several promising direct thrombin inhibitors and factor Xa inhibitors, and synthesize relevant drug information and clinical experience from the limited available case reports, case series, and nonrandomized dose-finding trials published to date.