Thromboprophylaxis for children hospitalized with COVID‐19 and MIS‐C
Abstract 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...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-07-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rth2.12780 |
| _version_ | 1797761663099731968 |
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| author | Anna H. Schmitz Kelly E. Wood Elliot L. Burghardt Bryan P. Koestner Linder H. Wendt Aditya V. Badheka Anjali A. Sharathkumar |
| author_facet | Anna H. Schmitz Kelly E. Wood Elliot L. Burghardt Bryan P. Koestner Linder H. Wendt Aditya V. Badheka Anjali A. Sharathkumar |
| author_sort | Anna H. Schmitz |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-12T19:16:21Z |
| format | Article |
| id | doaj.art-b6518041d97145368bac343b354ebb8c |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T19:16:21Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-b6518041d97145368bac343b354ebb8c2023-08-02T05:30:47ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792022-07-0165n/an/a10.1002/rth2.12780Thromboprophylaxis for children hospitalized with COVID‐19 and MIS‐CAnna H. Schmitz0Kelly E. Wood1Elliot L. Burghardt2Bryan P. Koestner3Linder H. Wendt4Aditya V. Badheka5Anjali A. Sharathkumar6Stead Family Department of Pediatrics University of Iowa Iowa City Iowa USAStead Family Department of Pediatrics University of Iowa Iowa City Iowa USACarver College of Medicine University of Iowa Iowa City Iowa USAStead Family Department of Pediatrics University of Iowa Iowa City Iowa USAInstitute for Clinical and Translational Science University of Iowa Iowa City Iowa USAStead Family Department of Pediatrics University of Iowa Iowa City Iowa USAStead Family Department of Pediatrics University of Iowa Iowa City Iowa USAAbstract 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.https://doi.org/10.1002/rth2.12780anticoagulantschildCOVID‐19heparinlow molecular weightMIS‐C |
| spellingShingle | Anna H. Schmitz Kelly E. Wood Elliot L. Burghardt Bryan P. Koestner Linder H. Wendt Aditya V. Badheka Anjali A. Sharathkumar Thromboprophylaxis for children hospitalized with COVID‐19 and MIS‐C Research and Practice in Thrombosis and Haemostasis anticoagulants child COVID‐19 heparin low molecular weight MIS‐C |
| title | Thromboprophylaxis for children hospitalized with COVID‐19 and MIS‐C |
| title_full | Thromboprophylaxis for children hospitalized with COVID‐19 and MIS‐C |
| title_fullStr | Thromboprophylaxis for children hospitalized with COVID‐19 and MIS‐C |
| title_full_unstemmed | Thromboprophylaxis for children hospitalized with COVID‐19 and MIS‐C |
| title_short | Thromboprophylaxis for children hospitalized with COVID‐19 and MIS‐C |
| title_sort | thromboprophylaxis for children hospitalized with covid 19 and mis c |
| topic | anticoagulants child COVID‐19 heparin low molecular weight MIS‐C |
| url | https://doi.org/10.1002/rth2.12780 |
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