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Thrombosis and Thromboprophylaxis in Pediatric Patients Admitted with COVID-19 Infection -- A Prospective Multicenter Observational Cohort Study
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  • Alexandra Zabeida,
  • Rochelle Winikoff,
  • Marie-Claude Pelland-Marcotte,
  • Janie Charlebois,
  • Christine Sabapathy
Alexandra Zabeida
Montreal Children's Hospital

Corresponding Author:[email protected]

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Rochelle Winikoff
CHU Sainte-Justine
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Marie-Claude Pelland-Marcotte
Centre hospitalier universitaire de Québec-Université Laval
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Janie Charlebois
Sherbrooke Hospital
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Christine Sabapathy
Montreal Children's Hospital
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Background/Objectives: A striking procoagulant state induced by SARS-CoV-2 (COVID-19) infection has been reported in adults, with many hospitalized patients developing thrombosis despite prophylactic anticoagulation. Reports on the characteristics of COVID-19-associated coagulopathy are scarce in the pediatric population and thromboprophylaxis use is heterogeneous across pediatric centers. To characterize laboratory and clinical outcomes of COVID-19-associated coagulopathy in children and to assess prophylactic anticoagulation use. Design/Methods: Prospective multicenter observational cohort study including all patients from 0 to 18 years of age admitted to one of the pediatric university health centers in the province of Québec, Canada, with confirmed COVID-19 infection from February 1 to July 1, 2021. Patient-level data including laboratory parameters, treatment and outcomes were obtained via chart review. Results: Included were 79 children hospitalized with COVID-19-related symptoms, multisystem inflammatory syndrome in children or an incidental finding of asymptomatic infection. When assessed, hemostatic parameters demonstrated elevation in D-dimers in 94.7%, fibrinogen in 60%, prothrombin time in 51.9%, and activated thromboplastin time in 18.5%. Platelet counts were normal in 91.3% of patients. Ten patients (12.3%) received thromboprophylaxis with low molecular weight heparin, 7 (8.9%) with aspirin and 1 (1.3%) with both. We observed one thrombosis and one major bleed, both attributable to an alternate diagnosis other than COVID-19 infection. Conclusion: The most consistent abnormal hemostatic parameters observed in this study were elevated D-dimers and fibrinogen. No thrombosis ascribable to COVID-19 infection has been observed in this pediatric cohort, despite relatively infrequent anticoagulant prophylaxis. There have been no bleeding events attributable to thromboprophylaxis.