How we approach thrombosis risk in children with COVID-19 infection and MIS-C

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Hematology

Background:

• Coronavirus disease 2019 (COVID-19) is associated with significant thrombotic complications, even in pediatric populations.
• Children with COVID-19 can develop thrombosis during acute illness and multisystem inflammatory syndrome in children (MIS-C).
• Current understanding of COVID-19-associated coagulopathy and pediatric thrombotic risk is limited, creating clinical challenges.

Observation:

• Thrombosis affects both microvasculature and larger vessels in critically ill patients with COVID-19.
• While severe COVID-19 is less common in children, they are still susceptible to thrombotic events.
• Multisystem inflammatory syndrome in children (MIS-C) is a post-acute complication linked to increased thrombotic risk.

Findings:

• Knowledge gaps exist regarding the precise mechanisms and extent of COVID-19-associated coagulopathy in children.
• Pediatric providers often rely on expert opinion and clinical experience due to limited evidence-based guidelines.
• Characterizing thrombosis risk and implementing thromboprophylaxis in pediatric COVID-19 cases requires careful consideration.

Implications:

• Developing clear guidelines for thrombosis risk assessment in pediatric COVID-19 is crucial.
• Evidence-based strategies for thromboprophylaxis in children with COVID-19 and MIS-C are needed.
• Further research is essential to elucidate COVID-19-associated coagulopathy and optimize patient management.