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Thrombotic events and prophylactic anticoagulation in pediatric patients with COVID-19: a systematic review and
Di Xie1, Xiaoming Xue2, Wenxiao Qiao1
1Shanxi Academy of Traditional Chinese Medicine, Taiyuan, Shanxi Province, People's Republic of China.
Insights
The incidence of venous thromboembolism (VTE) in children with COVID-19 is low. While prophylactic anticoagulant therapy showed high safety, it did not significantly reduce VTE risk in pediatric patients.
Area of Science:
- Pediatric medicine
- Infectious diseases
- Hematology
Background:
- COVID-19 in children can lead to venous thromboembolism (VTE).
- The effectiveness and safety of using anticoagulant therapy for VTE prevention in pediatric patients remain uncertain.
- This study addresses the need for clarity on VTE incidence, D-dimer association, and prophylactic treatment efficacy in children with COVID-19.
Conclusions:
- VTE incidence in children with COVID-19 is low, suggesting standard prophylaxis may be reasonable.
- Low-molecular-weight heparin (LMWH) demonstrates a high safety profile for VTE prevention.
- Further high-quality research is required to fully elucidate the impact of anticoagulant therapy on VTE incidence in pediatric COVID-19 cases.
Background:
Venous thromboembolism (VTE) can occur in children with COVID-19, and the efficacy and safety of prophylactic anticoagulant therapy are uncertain. This study aimed to assess the incidence of VTE in pediatric patients with COVID-19, the association of D-dimer with thrombus formation, and the effectiveness and safety of prophylactic anticoagulation treatment.
Methods:
We systematically searched databases from January 2020 to February 2023. A systematic review and meta-analysis were conducted to determine the incidence of VTE in children and evaluate the efficacy and safety of prophylactic anticoagulant therapy.
Results:
Thirteen cohort studies and one clinical trial were included. The pooled incidence rate of VTE in affected children was 1.5% (95% CI 0.4-2.9%). Children with D-dimer levels five times higher than normal had a higher risk of VTE (OR 4.92, 95% CI 1.60-15.11). Prophylactic anticoagulant therapy did not significantly reduce the risk of VTE (OR 1.35, 95% CI 0.74-2.49). The safety of prophylactic anticoagulant therapy was relatively high, with major bleeding and all-cause mortality rates below 0.1% (95% CI 0.0-0.2%).
Conclusions:
The incidence of VTE in children with COVID-19 is low, and prophylaxis based on ISTH standards is reasonable. Low-molecular-weight heparin (LMWH) for VTE prevention has a high level of safety. However, more high-quality studies are needed to understand the impact of anticoagulant therapy on VTE incidence in pediatric patients with COVID-19.
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