Thromboembolic complications in children with COVID-19 and MIS-C: A narrative review
COVID-19 and multisystem inflammatory syndrome in children (MIS-C) have been associated with a higher incidence of hypercoagulability and thromboembolic events (TEs), even in children, leading to relevant morbidity, and mortality. However, our understanding of such complications in childhood is limi...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.944743/full |
| _version_ | 1811217307942256640 |
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| author | Sandra Trapani Sandra Trapani Chiara Rubino Donatella Lasagni Francesco Pegoraro Massimo Resti Gabriele Simonini Gabriele Simonini Giuseppe Indolfi Giuseppe Indolfi |
| author_facet | Sandra Trapani Sandra Trapani Chiara Rubino Donatella Lasagni Francesco Pegoraro Massimo Resti Gabriele Simonini Gabriele Simonini Giuseppe Indolfi Giuseppe Indolfi |
| author_sort | Sandra Trapani |
| collection | DOAJ |
| description | COVID-19 and multisystem inflammatory syndrome in children (MIS-C) have been associated with a higher incidence of hypercoagulability and thromboembolic events (TEs), even in children, leading to relevant morbidity, and mortality. However, our understanding of such complications in childhood is limited. To better understand the incidence, clinical manifestations, risk factors, and management of COVID-19 and MIS-C-related TEs in children, a review of the current literature and a brief update on pathophysiology are given. Sixty-two studies, describing 138 patients with TEs associated with COVID-19 or MIS-C, were included. The overall number of TEs was 157, as 16 patients developed multiple TEs: venous TEs represented the majority (54%), followed by arterial thrombosis (38%, mainly represented by arterial ischemic stroke-AIS), and intracardiac thrombosis (ICT) (8%). Within the venous TEs group, pulmonary embolism (PE) was the most frequent, followed by deep venous thrombosis, central venous sinus thrombosis, and splanchnic venous thrombosis. Notably, 10 patients had multiple types of venous TEs, and four had both venous and arterial thrombosis including a newborn. Most of them (79 cases,57%) had at least one predisposing condition, being obesity the most frequent (21%), especially in patients with PE, followed by malignancy (9%). In 35% of cases, no data about the outcome were available About one-third of cases recovered, 12% improved at discharge or follow-up, and 6% had persistent neurological sequelae. The mortality rate was 12%, with death due to comorbidities in most cases. Most fatalities occurred in patients with arterial thrombosis. Pediatricians should be aware of this life-threatening possibility facing children with SARS-CoV-2 infection or its multisystemic inflammatory complication, who abruptly develop neurological or respiratory impairment. A prompt intensive care is essential to avoid severe sequelae or even exitus. |
| first_indexed | 2024-04-12T06:53:15Z |
| format | Article |
| id | doaj.art-f2928da517294e3d8b8667f9417ffab2 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-12T06:53:15Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-f2928da517294e3d8b8667f9417ffab22022-12-22T03:43:16ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-08-011010.3389/fped.2022.944743944743Thromboembolic complications in children with COVID-19 and MIS-C: A narrative reviewSandra Trapani0Sandra Trapani1Chiara Rubino2Donatella Lasagni3Francesco Pegoraro4Massimo Resti5Gabriele Simonini6Gabriele Simonini7Giuseppe Indolfi8Giuseppe Indolfi9Department of Health Sciences, Meyer Children’s University Hospital, University of Florence, Florence, ItalyPediatric Unit, Meyer Children’s University Hospital, Florence, ItalyPediatric Unit, Meyer Children’s University Hospital, Florence, ItalyPediatric Unit, Meyer Children’s University Hospital, Florence, ItalyDepartment of Health Sciences, Meyer Children’s University Hospital, University of Florence, Florence, ItalyPediatric Unit, Meyer Children’s University Hospital, Florence, ItalyRheumatology Unit, Meyer Children’s University Hospital, University of Florence, Florence, ItalyDepartment of NEUROFARBA, Meyer Children’s University Hospital, University of Florence, Florence, ItalyPediatric Unit, Meyer Children’s University Hospital, Florence, ItalyDepartment of NEUROFARBA, Meyer Children’s University Hospital, University of Florence, Florence, ItalyCOVID-19 and multisystem inflammatory syndrome in children (MIS-C) have been associated with a higher incidence of hypercoagulability and thromboembolic events (TEs), even in children, leading to relevant morbidity, and mortality. However, our understanding of such complications in childhood is limited. To better understand the incidence, clinical manifestations, risk factors, and management of COVID-19 and MIS-C-related TEs in children, a review of the current literature and a brief update on pathophysiology are given. Sixty-two studies, describing 138 patients with TEs associated with COVID-19 or MIS-C, were included. The overall number of TEs was 157, as 16 patients developed multiple TEs: venous TEs represented the majority (54%), followed by arterial thrombosis (38%, mainly represented by arterial ischemic stroke-AIS), and intracardiac thrombosis (ICT) (8%). Within the venous TEs group, pulmonary embolism (PE) was the most frequent, followed by deep venous thrombosis, central venous sinus thrombosis, and splanchnic venous thrombosis. Notably, 10 patients had multiple types of venous TEs, and four had both venous and arterial thrombosis including a newborn. Most of them (79 cases,57%) had at least one predisposing condition, being obesity the most frequent (21%), especially in patients with PE, followed by malignancy (9%). In 35% of cases, no data about the outcome were available About one-third of cases recovered, 12% improved at discharge or follow-up, and 6% had persistent neurological sequelae. The mortality rate was 12%, with death due to comorbidities in most cases. Most fatalities occurred in patients with arterial thrombosis. Pediatricians should be aware of this life-threatening possibility facing children with SARS-CoV-2 infection or its multisystemic inflammatory complication, who abruptly develop neurological or respiratory impairment. A prompt intensive care is essential to avoid severe sequelae or even exitus.https://www.frontiersin.org/articles/10.3389/fped.2022.944743/fullthrombosischildrenCOVID-19MIS-Cstrokeembolism |
| spellingShingle | Sandra Trapani Sandra Trapani Chiara Rubino Donatella Lasagni Francesco Pegoraro Massimo Resti Gabriele Simonini Gabriele Simonini Giuseppe Indolfi Giuseppe Indolfi Thromboembolic complications in children with COVID-19 and MIS-C: A narrative review Frontiers in Pediatrics thrombosis children COVID-19 MIS-C stroke embolism |
| title | Thromboembolic complications in children with COVID-19 and MIS-C: A narrative review |
| title_full | Thromboembolic complications in children with COVID-19 and MIS-C: A narrative review |
| title_fullStr | Thromboembolic complications in children with COVID-19 and MIS-C: A narrative review |
| title_full_unstemmed | Thromboembolic complications in children with COVID-19 and MIS-C: A narrative review |
| title_short | Thromboembolic complications in children with COVID-19 and MIS-C: A narrative review |
| title_sort | thromboembolic complications in children with covid 19 and mis c a narrative review |
| topic | thrombosis children COVID-19 MIS-C stroke embolism |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.944743/full |
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