PMID- 35949885
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230513
IS  - 2475-0379 (Electronic)
IS  - 2475-0379 (Linking)
VI  - 6
IP  - 5
DP  - 2022 Jul
TI  - Thromboprophylaxis for children hospitalized with COVID-19 and MIS-C.
PG  - e12780
LID - 10.1002/rth2.12780 [doi]
LID - e12780
AB  - 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.
CI  - (c) 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published 
      by Wiley Periodicals LLC on behalf of International Society on Thrombosis and 
      Haemostasis (ISTH).
FAU - Schmitz, Anna H
AU  - Schmitz AH
AUID- ORCID: 0000-0002-6631-1069
AD  - Stead Family Department of Pediatrics University of Iowa Iowa City Iowa USA.
AD  - Carver College of Medicine University of Iowa Iowa City Iowa USA.
FAU - Wood, Kelly E
AU  - Wood KE
AD  - Stead Family Department of Pediatrics University of Iowa Iowa City Iowa USA.
AD  - Carver College of Medicine University of Iowa Iowa City Iowa USA.
FAU - Burghardt, Elliot L
AU  - Burghardt EL
AD  - Carver College of Medicine University of Iowa Iowa City Iowa USA.
AD  - Department of Biostatistics, College of Public Health University of Iowa Iowa 
      City Iowa USA.
FAU - Koestner, Bryan P
AU  - Koestner BP
AD  - Stead Family Department of Pediatrics University of Iowa Iowa City Iowa USA.
AD  - Carver College of Medicine University of Iowa Iowa City Iowa USA.
FAU - Wendt, Linder H
AU  - Wendt LH
AD  - Institute for Clinical and Translational Science University of Iowa Iowa City 
      Iowa USA.
FAU - Badheka, Aditya V
AU  - Badheka AV
AD  - Stead Family Department of Pediatrics University of Iowa Iowa City Iowa USA.
AD  - Carver College of Medicine University of Iowa Iowa City Iowa USA.
FAU - Sharathkumar, Anjali A
AU  - Sharathkumar AA
AUID- ORCID: 0000-0003-4574-6175
AD  - Stead Family Department of Pediatrics University of Iowa Iowa City Iowa USA.
AD  - Carver College of Medicine University of Iowa Iowa City Iowa USA.
LA  - eng
GR  - T32 GM139776/GM/NIGMS NIH HHS/United States
GR  - UL1 TR002537/TR/NCATS NIH HHS/United States
PT  - Journal Article
DEP - 20220807
PL  - United States
TA  - Res Pract Thromb Haemost
JT  - Research and practice in thrombosis and haemostasis
JID - 101703775
PMC - PMC9357887
OTO - NOTNLM
OT  - COVID-19
OT  - MIS-C
OT  - anticoagulants
OT  - child
OT  - heparin
OT  - low molecular weight
OT  - thrombosis
OT  - venous thromboembolism
EDAT- 2022/08/12 06:00
MHDA- 2022/08/12 06:01
PMCR- 2022/08/07
CRDT- 2022/08/11 02:21
PHST- 2022/01/11 00:00 [received]
PHST- 2022/05/22 00:00 [revised]
PHST- 2022/06/28 00:00 [accepted]
PHST- 2022/08/11 02:21 [entrez]
PHST- 2022/08/12 06:00 [pubmed]
PHST- 2022/08/12 06:01 [medline]
PHST- 2022/08/07 00:00 [pmc-release]
AID - S2475-0379(22)00167-4 [pii]
AID - RTH212780 [pii]
AID - 10.1002/rth2.12780 [doi]
PST - epublish
SO  - Res Pract Thromb Haemost. 2022 Aug 7;6(5):e12780. doi: 10.1002/rth2.12780. 
      eCollection 2022 Jul.