ABSTRACT
Objectives COVID-19 and multisystem inflammatory syndrome in children (MIS-C) are associated with a risk of hypercoagulability and thrombotic events. We aimed (a) to evaluate the demographic, clinical, and laboratory findings as well as the incidence of thrombotic events of COVID-19 and MIS-C in children and (b) to determine the role of antithrombotic prophylaxis. Methods A single-center retrospective study evaluated hospitalized children with COVID-19 or MIS-C. Results The study group consisted of 690 patients, 596 (86.4%) diagnosed with COVID-19 and 94 (13.6%) diagnosed with MIS-C. Antithrombotic prophylaxis was used for 154 (22.3%) patients: 63 patients (10.6%) in the COVID-19 group and 91 (96.8%) patients in the MIS-C group. Use of antithrombotic prophylaxis was statistically higher in the MIS-C group (p<0.001). Patients who received antithrombotic prophylaxis were of older median age, were more commonly male, and had more frequent underlying diseases than those without prophylaxis (p<0.001, p<0.012, p<0.019, respectively). The most common underlying condition was obesity in patients who received antithrombotic prophylaxis. Thrombosis was observed in one (0.2%) patient in the COVID-19 group with a thrombus in the cephalic vein, two (2.1%) patients in the MIS-C group, with a dural thrombus in one patient and a cardiac thrombus in the other patient. The patients with thrombotic events were previously healthy and had mild disease. Conclusion In our study, thrombotic events were rare compared with previous reports. We used antithrombotic prophylaxis for most children with underlying risk factors;perhaps for this reason, we did not observe thrombotic events in children with underlying risk factors. We suggest that patients diagnosed with COVID-19 or MIS-C be closely monitored for thrombotic events.
ABSTRACT
OBJECTIVES: COVID-19 and multisystem inflammatory syndrome in children (MIS-C) are associated with a risk of hypercoagulability and thrombotic events. We aimed (a) to evaluate the demographic, clinical, and laboratory findings as well as the incidence of thrombotic events of COVID-19 and MIS-C in children and (b) to determine the role of antithrombotic prophylaxis. METHODS: A single-center retrospective study evaluated hospitalized children with COVID-19 or MIS-C. RESULTS: The study group consisted of 690 patients, 596 (86.4%) diagnosed with COVID-19 and 94 (13.6%) diagnosed with MIS-C. Antithrombotic prophylaxis was used for 154 (22.3%) patients: 63 patients (10.6%) in the COVID-19 group and 91 (96.8%) patients in the MIS-C group. Use of antithrombotic prophylaxis was statistically higher in the MIS-C group (p<0.001). Patients who received antithrombotic prophylaxis were of older median age, were more commonly male, and had more frequent underlying diseases than those without prophylaxis (p<0.001, p<0.012, p<0.019, respectively). The most common underlying condition was obesity in patients who received antithrombotic prophylaxis. Thrombosis was observed in one (0.2%) patient in the COVID-19 group with a thrombus in the cephalic vein, two (2.1%) patients in the MIS-C group, with a dural thrombus in one patient and a cardiac thrombus in the other patient. The patients with thrombotic events were previously healthy and had mild disease. CONCLUSION: In our study, thrombotic events were rare compared with previous reports. We used antithrombotic prophylaxis for most children with underlying risk factors; perhaps for this reason, we did not observe thrombotic events in children with underlying risk factors. We suggest that patients diagnosed with COVID-19 or MIS-C be closely monitored for thrombotic events.
Subject(s)
COVID-19 , Thrombosis , Humans , Child , Male , COVID-19/complications , Fibrinolytic Agents , Retrospective Studies , Thrombosis/etiology , Thrombosis/prevention & controlABSTRACT
Background : Thromboelastography (TEG) may estimate the dynamics of blood coagulation from the activation of clotting factors to fibrin formation, clot stabilization, and clot lysis. Therefore, TEG may be helpful to predict thromboembolic events and estimate clinical outcome in patients with COVID-19. Aims : In this study, we wanted to evaluate the coagulation abnormalities including TEG analyses in children that are hospitalized for COVID-19 and aimed to assess the utility of TEG in clinical practice in terms of course of the disease, treatment response, and outcome. Methods : A total of 66 patients who were ≤18 years old and hospitalized in infection ward for COVID-19 were evaluated prospectively. Clinical and laboratory findings at admission, course of the disease, treatment modalities, development of MIS-C, and outcome of patients were noted. Haemoscope TEG analyzer (Haemoscope, USA) was used. Results : Five patients (7.6%) had thrombocytopenia. PT was prolonged in 5 patients (7.6%) and APTT in 3 patients (4.5%). Eight patients (12.1%) had elevated levels of D-dimer. A total of 16 patients (24.2%) had at least one abnormality at in TEG analysis. Eleven patients (16.6%) had an abnormality related to hypercoagulation such as decreased R/K, increased MA/Angle or increased CI. MIS-C developed in 3 patients (4.5%) during clinical follow-up;all of them had a normal graphic for TEG, even though they had increased D-dimer levels (>3000 ng/mL) at admission. There was no difference in TEG abnormalities between treated and untreated patients ( P = 0.76). Thromboembolic complications or bleeding events were not observed. None of the patients needed mechanical ventilation. None of them died. Conclusions : Abnormal TEG features may be the most common finding regarding coagulopathy at admission in these patients, followed by elevated D-dimer levels. Abnormal TEG results at admission is not able to predict the course of the disease, treatment results, and outcome in pediatric patients who did not need mechanical ventilation.