SARS-COV-2-associated coagulopathy and thromboembolism prophylaxis in children: A single-center observational study.
Adolescent
Age Factors
Anticoagulants
/ therapeutic use
Biomarkers
/ blood
Blood Coagulation
/ drug effects
Blood Coagulation Disorders
/ blood
COVID-19
/ blood
Child
Child, Preschool
Clinical Decision-Making
Female
Hospitalization
Humans
Infant
Infant, Newborn
Italy
Male
Prospective Studies
Risk Factors
Thromboembolism
/ blood
Time Factors
Treatment Outcome
Young Adult
COVID-19 Drug Treatment
COVID-19
blood coagulation tests
child
enoxaparin
thrombosis
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
15
05
2020
revised:
09
11
2020
accepted:
07
12
2020
pubmed:
12
12
2020
medline:
5
3
2021
entrez:
11
12
2020
Statut:
ppublish
Résumé
Multiple investigators have described an increased incidence of thromboembolic events in SARS-CoV-2-infected individuals. Data concerning hemostatic complications in children hospitalized for COVID-19/multisystem inflammatory syndrome in children (MIS-C) are scant. To share our experience in managing SARS-CoV-2-associated pro-coagulant state in hospitalized children. D-dimer values were recorded at diagnosis in children hospitalized for SARS-CoV-2-related manifestations. In moderately to critically ill patients and MIS-C cases, coagulation and inflammatory markers were checked at multiple time points and median results were compared. Pro-thrombotic risk factors were appraised for each child and thromboprophylaxis was started in selected cases. Thirty-five patients were prospectively enrolled. D-dimer values did not discriminate COVID-19 of differing severity, whereas were markedly different between the COVID-19 and the MIS-C cohorts. In both cohorts, D-dimer and C-reactive protein levels increased upon clinical worsening but were not accompanied by decreased fibrinogen or platelet values, with all parameters returning to normal upon disease resolution. Six patients had multiple thrombotic risk factors and were started on pharmacological thromboprophylaxis. No deaths or thrombotic or bleeding complications occurred. COVID-19 pediatric patients show mildly altered coagulation and inflammatory parameters; on the other hand, MIS-C cases showed laboratory signs of an inflammatory driven pro-coagulant status. Universal anticoagulant prophylaxis in hospitalized children with SARS-CoV-2-related manifestations is not warranted, but may be offered to patients with other pro-thrombotic risk factors in the context of a multi-modal therapeutic approach.
Sections du résumé
BACKGROUND
BACKGROUND
Multiple investigators have described an increased incidence of thromboembolic events in SARS-CoV-2-infected individuals. Data concerning hemostatic complications in children hospitalized for COVID-19/multisystem inflammatory syndrome in children (MIS-C) are scant.
OBJECTIVES
OBJECTIVE
To share our experience in managing SARS-CoV-2-associated pro-coagulant state in hospitalized children.
METHODS
METHODS
D-dimer values were recorded at diagnosis in children hospitalized for SARS-CoV-2-related manifestations. In moderately to critically ill patients and MIS-C cases, coagulation and inflammatory markers were checked at multiple time points and median results were compared. Pro-thrombotic risk factors were appraised for each child and thromboprophylaxis was started in selected cases.
RESULTS
RESULTS
Thirty-five patients were prospectively enrolled. D-dimer values did not discriminate COVID-19 of differing severity, whereas were markedly different between the COVID-19 and the MIS-C cohorts. In both cohorts, D-dimer and C-reactive protein levels increased upon clinical worsening but were not accompanied by decreased fibrinogen or platelet values, with all parameters returning to normal upon disease resolution. Six patients had multiple thrombotic risk factors and were started on pharmacological thromboprophylaxis. No deaths or thrombotic or bleeding complications occurred.
CONCLUSIONS
CONCLUSIONS
COVID-19 pediatric patients show mildly altered coagulation and inflammatory parameters; on the other hand, MIS-C cases showed laboratory signs of an inflammatory driven pro-coagulant status. Universal anticoagulant prophylaxis in hospitalized children with SARS-CoV-2-related manifestations is not warranted, but may be offered to patients with other pro-thrombotic risk factors in the context of a multi-modal therapeutic approach.
Identifiants
pubmed: 33305475
doi: 10.1111/jth.15216
pmc: PMC9906296
pii: S1538-7836(22)00667-5
doi:
Substances chimiques
Anticoagulants
0
Biomarkers
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
522-530Informations de copyright
© 2020 International Society on Thrombosis and Haemostasis.
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