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Published on: August 18, 2015
Thromboprophylaxis for children hospitalized with COVID-19 and MIS-C
Anna H Schmitz1,2, Kelly E Wood1,2, Elliot L Burghardt2,3
1Stead Family Department of Pediatrics University of Iowa Iowa City Iowa USA.
Insights
Pharmacological thromboprophylaxis using tailored low-molecular-weight heparin regimens is effective for preventing venous thromboembolism (VTE) in children hospitalized with COVID-19 and multisystem inflammatory syndrome (MIS-C). This approach appears safe and warrants inclusion in standard care.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Infectious diseases
Background:
- Limited data exist on effective pharmacological thromboprophylaxis for children with acute COVID-19 and MIS-C.
- Venous thromboembolism (VTE) is a potential complication in these pediatric populations.
Purpose of the Study:
- To evaluate the outcomes of an institutional thromboprophylaxis protocol for primary VTE prevention in hospitalized children with COVID-19 or MIS-C.
- To assess the safety and efficacy of tailored intensity thromboprophylaxis.
Main Methods:
- Retrospective cohort study of children (<21 years) with COVID-19/MIS-C receiving thromboprophylaxis (primarily low-molecular-weight heparin) from April 2020 to October 2021.
- Thromboprophylaxis was guided by disease severity (WHO scale) and VTE risk factors, with therapeutic intensity considered for severe illness.
- Outcomes included incident VTEs, bleeding events, and mortality.
Main Results:
- Of 211 hospitalizations, 45 (21.3%) received thromboprophylaxis (16 COVID-19, 29 MIS-C).
- One VTE (2.2%) and one death (2.2%, unrelated to thrombosis/bleeding) occurred. No major or clinically relevant nonmajor bleeding events were observed; minor bleeding occurred in 7 (15.5%).
- D-dimer levels were elevated at diagnosis but normalized upon discontinuation of thromboprophylaxis.
Conclusions:
- Clinically directed thromboprophylaxis with a tailored intensity approach for children hospitalized with COVID-19 and MIS-C is favored for inclusion in standard care.
- The utility of D-dimer in guiding thromboprophylaxis management requires further investigation.
Background:
Limited data exist about effective regimens for pharmacological thromboprophylaxis in children with acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C).
Objectives:
Study the outcomes of institutional thromboprophylaxis protocol for primary venous thromboembolism (VTE) prevention in children hospitalized with acute COVID-19/MIS-C.
Methods:
This single-center retrospective cohort study included consecutive children (aged less than 21 years) with COVID-19/MIS-C who received tailored intensity thromboprophylaxis, primarily with low-molecular-weight heparin, from April 2020 through October 2021. Thromboprophylaxis was given to those with moderate to severe disease based on the World Health Organization scale and exposure to two or more VTE risk factors. Therapeutic intensity was considered for severe illness. Clinical recovery along with D-dimer improvement determined thromboprophylaxis duration. Outcomes were incident VTEs, bleeding, and mortality.
Results:
Among 211 hospitalizations, 45 (21.3%) received thromboprophylaxis (COVID-19, 16; MIS-C, 29). Median age was 14.8 years (interquartile range [IQR], 8.9-16.1). Among 35 (77.8%) with severe illness, 27 (60.0%) required respiratory support, and 19 (42.2%) required an intensive care unit stay. Median hospitalization was 6 days (IQR, 5.0-10.5). Median thromboprophylaxis duration was 19 days (IQR, 6.0-31.0) with therapeutic intensity in 24 (53.3%) and prophylactic in 21 (46.7%). Outcomes were as follows: VTE, 1 (2.2%); death, 1 (2.2%, unrelated to bleeding/thrombosis); major/clinically relevant nonmajor bleeding, 0; and minor bleeding, 7 (15.5%). D-dimer was elevated in a majority at diagnosis (median, 2.3; IQR, 1.2-3.3 mg/ml fibrinogen-equivalent units) and was noninformative in assessing disease severity. D-dimer normalized at thromboprophylaxis discontinuation.
Conclusions:
Our experience of using clinically directed thromboprophylaxis with tailored intensity approach for children hospitalized with COVID-19 and MIS-C favors its inclusion in current standard of care. The role of D-dimer in directing thromboprophylaxis management deserves further evaluation.
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