Are children with SARS‐CoV‐2 infection at high risk for thrombosis? Viscoelastic testing and coagulation profiles in a case series of pediatric patients

Abstract

The coagulopathy of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is well documented in adults, with increases in D-dimer and prothrombin time found to be strong predictors of mortality, and anticoagulation shown to decrease this mortality. Viscoelastic parameters such as elevations in maximum clot firmness (MCF) on rotational thromboelastometry (ROTEM) have correlated with a hypercoagulable state in adults with SARS-CoV-2. We report our experience in children infected with SARS-CoV-2, with noted elevations in D-dimer and MCF on ROTEM (indicating hypercoagulability). Exploration of viscoelastic testing to provide additional laboratory-based evidence for pediatric-specific risk assessment for thromboprophylaxis in SARS-CoV-2 is warranted.

Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

“…The remaining 145 patients were sex-and age-matched non-COVID-19 controls hospitalized either in the ICU (89 patients) or in IMW (56 patients) for ARDS (acute respiratory distress syndrome) or pneumonia non-related to SARS-CoV-2, or for postoperative care. One article [33] reported data about eight hospitalized children either in a pediatric ward or in a pediatric ICU (PICU).…”

“…Among articles reporting data about TEG, four were prospective studies [52,[59][60][61], ten were retrospective studies [51,[53][54][55][56][57][58][62][63][64], and one was a case report [65]. Among articles dealing with ROTEM, thirteen were prospective studies [28][29][30][31][32][39][40][41][42][43][44][45][46], seven were retrospective studies [27,[33][34][35][36]48,49], one was a cross-sectional study [47], and four were case reports [26,37,38,50].…”

“…Testing was carried out either on admission or within the following days, but the timing of blood collection for VET was specified only for 29 studies [24,26,27,[29][30][31]33,[35][36][37][38]41,[43][44][45][46][47][48]50,53,[55][56][57][58][59][65][66][67]. In some studies, the measurements were repeated during the patientʹs stay, either because of a pre-established protocol [26,27,29,45,53,59,60,67] or because of the occurrence of a thromboembolic event [65,68].…”

“…Mean or median adult COVID-19 patients ages ranged from 39 [65] to 84 years [68]. Excluding case reports, the proportion of women among the studies reporting gender ranged from 0 [40] to 50% [29,33,36].…”

Hospitalized Children With Familial Hypercholesterolemia and COVID-19: A Case for Preventive Anticoagulation

“…Al-Ghafry et al (21) recently published a case series of eight hospitalized COVID-19 pediatric patients, in which the coagulation profiles were determined. Six children had elevated D-dimer levels and required oxygen supplementation, and five children also required intensive care unit treatment.…”