Children and young adults hospitalized for  severe COVID-19 exhibit thrombotic coagulopathy        

Abstract

We report the clinical and laboratory coagulation characteristics of 27 pediatric and young adult patients (2 months to 21 years) treated for symptomatic COVID-19 at a children’s hospital in the Bronx, New York between March 1 and May 31, 2020. D-Dimer was > 0.5 ug/mL (upper limit of normal) in 25 (93%) patients at admission; 11 (41%) developed peak D-Dimer > 5 ug/mL during admission. Seven (26%) patients developed venous thromboembolism: three with deep vein thrombosis and four with pulmonary embolism. Requirement of increased ventilatory support was a risk factor for thrombosis (p=0.006). Three of eight (38%) patients on prophylactic anticoagulation developed thrombosis, however no patients developed VTE on low molecular weight heparin prophylaxis titrated to anti-Xa level. Manifestation of COVID-19 disease was severe or critical in 16 (59%) patients. Four (15%) patients died of COVID-19 complications: all had comorbidities. Elevated D-dimer and increased VTE rate were observed in this young cohort, particularly in those with severe respiratory complications suggesting thrombotic coagulopathy. More data is needed to guide thromboprophylaxis in this age group.

Adolescent subdural empyema in setting of COVID-19 infection: illustrative case

“…14 In subanalysis, the severely ill patients with COVID-19 who did not survive had the highest PT values of 15.5 seconds (INR 1.3-1.4), on average. 14 15 Potential contributing factors to the coagulopathy observed for our patient include systemic inflammatory changes associated with COVID-19 and inflammatory changes associated with sinusitis/empyema. Documented hematological sequelae of COVID-19 also include thrombosis/hypercoagulability, 16 which is relevant to the uncertain risk of multiple procoagulant blood product infusion in this case.…”

Thrombosis and hemorrhage experienced by hospitalized children with SARS‐CoV‐2 infection or MIS‐C: Results of the PICNIC registry

“…(5/398), and 26% (7/27). [36][37][38][39] Between January 2021 to November 2021, the prevalence was 0.7% (4/537) to 2.1% (9/426). 14,40 In children with MIS-C, the reported rate of thrombosis ranged from 4.3% (8/186) to 6.5% (9/138) in larger studies, 14,41 with two small studies reporting no thrombotic events in MIS-C patients (N = 6 and N = 30).…”

“…Published pediatric literature on thrombosis in SARS‐CoV‐2 infection provides variable rates of thrombosis. From March 2020 to December 2020, the reported prevalence of thrombotic events in children with primary SARS‐CoV‐2 infection was 0.8% ( N = 8/971), 1.2% (5/398), and 26% (7/27) 36–39 . Between January 2021 to November 2021, the prevalence was 0.7% (4/537) to 2.1% (9/426) 14,40 .…”

SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association

“…63 Although rare, severe neurological complications such as encephalitis, seizures, and strokes and thromboembolic events, including deep vein thrombosis and pulmonary embolism, have been described in children and young adults. 11,64–66…”