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Children and young adults hospitalized for severe COVID-19 exhibit thrombotic coagulopathy

William B Mitchell1, Jennifer Davila1, Janine Keenan1

  • 1Albert Einstein College of Medicine, Department of Pediatrics, Division of Hematology and Oncology, Bronx, New York.

Pediatric Blood & Cancer
|March 4, 2021
PubMed

Insights

This study found that pediatric COVID-19 patients often have elevated D-dimer levels and a high risk of venous thromboembolism (VTE), especially with severe respiratory illness. Low-molecular-weight heparin showed promise for VTE prevention in this group.

Area of Science:

  • Pediatric Hematology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • COVID-19 presents unique challenges in pediatric populations.
  • Coagulation abnormalities and venous thromboembolism (VTE) are known complications of COVID-19 in adults.
  • Data on thrombotic coagulopathy in pediatric COVID-19 patients are limited.

Purpose of the Study:

  • To characterize the clinical and laboratory coagulation findings in pediatric and young adult patients with symptomatic COVID-19.
  • To determine the incidence of VTE in this cohort.
  • To identify risk factors for thrombosis and evaluate the efficacy of prophylactic anticoagulation.

Main Methods:

  • Retrospective analysis of 27 pediatric patients (2 months to 21 years) treated for COVID-19.
  • Assessment of D-dimer levels, VTE events (deep vein thrombosis, pulmonary embolism), and need for ventilatory support.
  • Evaluation of outcomes in patients receiving prophylactic anticoagulation, including low-molecular-weight heparin (LMWH).

Main Results:

  • 93% of patients had elevated D-dimer on admission; 41% developed peak levels >5 μg/mL.
  • 26% of patients developed VTE (3 deep vein thrombosis, 4 pulmonary embolism).
  • Increased ventilatory support was a significant risk factor for thrombosis (P=0.006). No VTE occurred in patients on LMWH prophylaxis titrated to anti-Xa levels.

Conclusions:

  • Pediatric and young adult COVID-19 patients exhibit elevated D-dimer and a notable VTE rate, suggesting thrombotic coagulopathy.
  • Severe respiratory complications are associated with increased thrombosis risk.
  • Further research is needed to establish optimal thromboprophylaxis strategies for pediatric COVID-19 patients.

Keywords:
COVID-19SARS-Co-V2pediatricthrombosisvenous thromboembolismyoung adult

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