Thrombosis and Thromboprophylaxis in Pediatric Patients Admitted with
COVID-19 Infection -- A Prospective Multicenter Observational Cohort
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