Prevalence of thrombotic complications in children with SARS-CoV-2

Abstract

Knowledge of thrombosis in children with SARS-CoV-2 is scarce. In this multicentre national cohort of children with SARS-CoV-2 involving 49 hospitals, 4 patients out of 537 infected children developed a thrombotic complication (prevalence of 0.7% (95% CI: 0.2% to 1.9%) out of the global cohort and 1.1% (95% CI: 0.3% to 2.8%) out of the hospitalised patients). We describe their characteristics and review other published paediatric cases. Three out of the four patients were adolescent girls, and only two cases had significant thrombotic risk factors. In this paediatric cohort, D-dimer value was not specific enough to predict thrombotic complications. Adolescence and previous thrombotic risk factors may be considered when initiating anticoagulant prophylaxis on children with SARS-CoV-2 disease (COVID-19).

Association between Coagulation Profile and Clinical Outcome in Children with SARS-CoV-2 Infection or MIS-C: A Multicenter Cross-Sectional Study

“…This is probably due to the low number of children that developed thrombo-embolic phenomena (3/316, about 1% of the study population). This number is in line with the only study that addressed thrombotic events in a large cohort of children in Spain, where 4 patients out of 537 infected children developed a thrombotic complication (prevalence of 0.7% (95% CI: 0.2% to 1.9%) out of the global cohort and 1.1% (95% CI: 0.3% to 2.8%) out of the hospitalized patients) [ 29 ]. Furthermore, in this study, the D-dimer value was not specific enough to predict thrombotic complications.…”

Intracardiac thrombosis in the three-year-old boy with normal left ventricle systolic function in MIS-C associated with COVID-19

“…A multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, a newly described condition, is a hypercoagulable state caused by hyper inflammation and cytokine storm. [1][2][3][4] Although more than half of the patients with MIS-C (76%) have biochemical evidence of coagulopathy, the prevalence of deep vein thrombosis or pulmonary emboli is low (8%). On the other hand, the most extensive published MIS-C case series have not reported thrombotic complications.…”

“…On the other hand, the most extensive published MIS-C case series have not reported thrombotic complications. [1][2][3][4] Intracardiac thrombus is not a common condition in otherwise healthy children, and the most common location is the right-sided chambers. A left-sided intracardiac thrombus is almost always associated with left ventricular (LV) dysfunction or arrhythmia.…”

“…10 SARS-CoV-2 inducted endothelial dysfunction leads to activation of the external coagulation pathway. [1][2][3][4] On the other hand, increased IL-6 and other cytokines establish a prothrombotic state by disabling the natural anticoagulants. 8 Consequently, our patient had a transient hypercoagulable state, likely secondary to the recent SARS-CoV-2 infection.…”

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“…385 Even with vaccination, kids will need ivermectin against thrombotic complications caused by the virus. 386 There's no need for vaccination if there's a more effective and safer strategy like ivermectin.…”