Coagulation Abnormalities and Management in Hospitalized Pediatric Patients With COVID-19.
Journal
The Pediatric infectious disease journal
ISSN: 1532-0987
Titre abrégé: Pediatr Infect Dis J
Pays: United States
ID NLM: 8701858
Informations de publication
Date de publication:
01 07 2022
01 07 2022
Historique:
pubmed:
8
4
2022
medline:
11
6
2022
entrez:
7
4
2022
Statut:
ppublish
Résumé
The incidence and severity of coagulation abnormalities have not been extensively studied in pediatric populations with coronavirus disease 2019 (COVID-19). Moreover, their association with an increased risk for thromboembolic events remains unclear, and there is a lack of evidence for optimal prophylactic antithrombotic management. The aim of our study was to present our experience in evaluation, management, and long-term outcomes of coagulation abnormalities in pediatric hospitalized patients with COVID-19. A prospective study was performed in all children hospitalized for COVID-19 during a 6-month period focusing on patients' coagulation abnormalities, the normalization of the coagulation profile with or without anticoagulation prophylaxis and the clinical outcome of the disease. Two hundred twenty-three patients (median age: 11.4 months) were enrolled in the study. Coagulation abnormalities were detected in 92.4% of patients with increased D-dimer levels to be the most common abnormality detected in 84.3% of patients. Prophylactic anticoagulation was initiated only in 7 (3.1%) selected patients with severe COVID-19 and at least 2 risk factors for venous thromboembolism (VTE) and in all patients with previous history of VTE. Follow-up coagulation profile in 85 patients showed that changes over time had a tendency towards normalization irrespectively of the initiation of anticoagulant thromboprophylaxis. No thrombotic complications were observed 3 months upon discharge. Although abnormal findings in coagulation profile were very common, they were not associated with risk for VTE even in severe cases. A trend of normalization early in the course of the disease was observed regardless of the use of anticoagulant thromboprophylaxis.
Sections du résumé
BACKGROUND
The incidence and severity of coagulation abnormalities have not been extensively studied in pediatric populations with coronavirus disease 2019 (COVID-19). Moreover, their association with an increased risk for thromboembolic events remains unclear, and there is a lack of evidence for optimal prophylactic antithrombotic management. The aim of our study was to present our experience in evaluation, management, and long-term outcomes of coagulation abnormalities in pediatric hospitalized patients with COVID-19.
METHODS
A prospective study was performed in all children hospitalized for COVID-19 during a 6-month period focusing on patients' coagulation abnormalities, the normalization of the coagulation profile with or without anticoagulation prophylaxis and the clinical outcome of the disease.
RESULTS
Two hundred twenty-three patients (median age: 11.4 months) were enrolled in the study. Coagulation abnormalities were detected in 92.4% of patients with increased D-dimer levels to be the most common abnormality detected in 84.3% of patients. Prophylactic anticoagulation was initiated only in 7 (3.1%) selected patients with severe COVID-19 and at least 2 risk factors for venous thromboembolism (VTE) and in all patients with previous history of VTE. Follow-up coagulation profile in 85 patients showed that changes over time had a tendency towards normalization irrespectively of the initiation of anticoagulant thromboprophylaxis. No thrombotic complications were observed 3 months upon discharge.
CONCLUSIONS
Although abnormal findings in coagulation profile were very common, they were not associated with risk for VTE even in severe cases. A trend of normalization early in the course of the disease was observed regardless of the use of anticoagulant thromboprophylaxis.
Identifiants
pubmed: 35389967
doi: 10.1097/INF.0000000000003545
pii: 00006454-202207000-00011
pmc: PMC9177125
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
570-574Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no funding or conflicts of interest to disclose.
Références
Marietta M, Coluccio V, Luppi M. COVID-19, coagulopathy and venous thromboembolism: more questions than answers. Intern Emerg Med. 2020;15:1375–1387.
Biswas I, Khan GA. Coagulation disorders in COVID-19: role of toll-like receptors. J Inflamm Res. 2020;13:823–828.
Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18:844–847.
Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18:1023–1026.
Song JC, Wang G, Zhang W, et al.; People’s Liberation Army Professional Committee of Critical Care Medicine, Chinese Society on Thrombosis and Haemostasis. Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19. Mil Med Res. 2020;7:19.
Loi M, Branchford B, Kim J, et al. COVID-19 anticoagulation recommendations in children. Pediatr Blood Cancer. 2020;67:e28485.
Goldenberg NA, Sochet A, Albisetti M, et al.; Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee of the ISTH SSC. Consensus-based clinical recommendations and research priorities for anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illness. J Thromb Haemost. 2020;18:3099–3105.
Jiang L, Tang K, Levin M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis. 2020;20:e276–e288.
National Institutes of Health (NIH). COVID-19 treatment guidelines. Available at: https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/ .
Branchford BR, Mahajerin A, Raffini L, et al.; Subcommittee on Pediatric/Neonatal Hemostasis and Thrombosis. Recommendations for standardized risk factor definitions in pediatric hospital-acquired venous thromboembolism to inform future prevention trials: communication from the SSC of the ISTH. J Thromb Haemost. 2017;15:2274–2278.
Graff K, Smith C, Silveira L, et al. Risk factors for severe COVID-19 in children. Pediatr Infect Dis J. 2021;40:e137–e145.
Zhou B, Yuan Y, Wang S, et al. Risk profiles of severe illness in children with COVID-19: a meta-analysis of individual patients. Pediatr Res. 2021;90:347–352.
Irfan O, Muttalib F, Tang K, et al. Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis. Arch Dis Child. 2021;106:440–8.
Whitworth H, Sartain SE, Kumar R, et al. Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C. Blood. 2021;138:190–198.
Appel IM, Grimminck B, Geerts J, et al. Age dependency of coagulation parameters during childhood and puberty. J Thromb Haemost. 2012;10:2254–2263.
Lippi G, Bonfanti L, Saccenti C, et al. Causes of elevated D-dimer in patients admitted to a large urban emergency department. Eur J Intern Med. 2014;25:45–48.
Levi M, Thachil J, Iba T, et al. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7:e438–e440.
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062.
Gazzaruso C, Paolozzi E, Valenti C, et al. Association between antithrombin and mortality in patients with COVID-19. A possible link with obesity. Nutr Metab Cardiovasc Dis. 2020;30:1914–1919.
Maldonado E, Tao D, Mackey K. Antithrombotic therapies in COVID-19 disease: a systematic review. J Gen Intern Med. 2020;35:2698–2706.
Rauch A, Labreuche J, Lassalle F, et al. Coagulation biomarkers are independent predictors of increased oxygen requirements in COVID-19. J Thromb Haemost. 2020;18:2942–2953.
Del Borrello G, Giraudo I, Bondone C, et al. SARS-COV-2-associated coagulopathy and thromboembolism prophylaxis in children: a single-center observational study. J Thromb Haemost. 2021;19:522–530.
Feldstein LR, Rose EB, Horwitz SM, et al.; Overcoming COVID-19 Investigators; CDC COVID-19 Response Team. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383:334–346.
Aronoff SC, Hall A, Del Vecchio MT. The natural history of severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children: a systematic review. J Pediatric Infect Dis Soc. 2020;9:746–751.
Garazzino S, Montagnani C, Donà D, et al. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. Euro Surveill. 2020;25:2000600.
Malas MB, Naazie IN, Elsayed N, et al. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: a systematic review and meta-analysis. EClinicalMedicine. 2020;29:100639.
Ignjatovic V, Mertyn E, Monagle P. The coagulation system in children: developmental and pathophysiological considerations. Semin Thromb Hemost. 2011;37:723–729.
Johns Hopkins All Children's H. COVID-19 anticoagulation in children - thromboprophlaxis (COVAC-TP) Trial 2021 [updated June 4]. Available at: https://ClinicalTrials.gov/show/NCT04354155 .