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Thrombotic and Bleeding Complications in Paediatric Inflammatory Multisystem Syndrome Temporarily Associated with COVID-19 (PIMS-TS) in Children: a Systematic Review

1Mayo Clinic, Rochester, Minnesota, United States, 2CHUL Hospital, Quebec City, Quebec, Canada, 3Leeds Children Hospital, Leeds, England, United Kingdom, 4Princess Máxima Center for pediatric oncology, Utrecht, Utrecht, Netherlands, 5The Hospital for Sick Children, Toronto, Ontario, Canada, 6The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada, Toronto, Ontario, Canada

Abstract Number: OC 08.2

Meeting: ISTH 2022 Congress

Theme: Pediatrics » Thrombosis in Neonates and Children

Background: Paediatric Inflammatory Multisystem Syndrome Temporarily Associated with COVID-19 in Children (PIMS-TS) is a newly defined inflammatory disease following COVID-19 infection. Limited reports exist investigating thrombosis/bleeding in PIMS-TS.

Aims: To describe the thrombotic and bleeding complications in this population.

Methods: A systematic literature review was conducted searching MEDLINE®, EMBASE and Cochrane Libraries from inception until May 29, 2021. Primary outcomes were prevalence of thrombotic and bleeding complications; secondary outcomes evaluated the anticoagulation regimens used.

Results: One hundred and thirty-two studies met eligibility criteria (124 retrospective, 8 prospective; figure 1) describing 3240 patients (male 58%; mean age 8.3 yrs ± 2.2; table 1). PIMS-TS subtypes (table 1) included shock (47%), fever and inflammation (21%) and Kawasaki disease (4%). Two-thirds of patients (65%; 2118/3240) were critically ill, 40% (1295/3240) required inotropic use, and 2% (58/3240) required ECMO support. Half of patients received anticoagulation (51%; 1638/3240; therapeutic [120]; prophylactic [408]; risk-stratified approach [14]; not specified [1096]) and/or antiplatelet therapy (51%; 1659/3240). Thrombotic events (TE) were reported in about 3% (62/2057) of patients, with DVT/PE (50%; 31/62) being the most common followed by ischemic strokes (IS, 21%; 13/62), and cardiac thrombosis (11%; 7/62). Clinically, TE patients required more mechanical ventilation (MV, 65% vs 20%*) and ECMO support (35% vs 1%*), presenting a higher mortality rate (11% vs 2%*). Bleeding was reported in 2.6% (16/618), of which 60% (10/16) were major bleeding events (MBE). Patients with MBE were more likely to be on ECMO (50% vs 2%*) and MV (70% vs 17%*), and four patients died (40%, 4/10; 2 had concurrent TE).

Conclusion(s): Patients with PIMS-TS are at risk of thrombosis despite widespread anticoagulation use, particularly in critically ill patients (i.e., requiring MV and/or ECMO). MBE are also prevalent in this same risk group and associated with mortality. A risk-stratified anticoagulation approach requires further investigation.

* p value < 0.01

To cite this abstract in AMA style:

Al-Huniti A, Renzi S, Ali S, Langenberg-Ververgaert K, Laxer R, Brandão L. Thrombotic and Bleeding Complications in Paediatric Inflammatory Multisystem Syndrome Temporarily Associated with COVID-19 (PIMS-TS) in Children: a Systematic Review [abstract]. https://abstracts.isth.org/abstract/thrombotic-and-bleeding-complications-in-paediatric-inflammatory-multisystem-syndrome-temporarily-associated-with-covid-19-pims-ts-in-children-a-systematic-review/. Accessed September 22, 2023.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/thrombotic-and-bleeding-complications-in-paediatric-inflammatory-multisystem-syndrome-temporarily-associated-with-covid-19-pims-ts-in-children-a-systematic-review/