Abstract Number: OC 40.1
Meeting: ISTH 2021 Congress
Background: Limited data exists on the thrombosis risk in pediatric patients hospitalized with COVID-19 or Multisystem Inflammatory Syndrome in Children (MIS-C).
Aims: Describe clinical characteristics and risk factors of thrombosis in pediatric patients diagnosed with COVID-19/MIS-C.
Methods: Reviewed a single-center IRB approved registry of patients (<21 years) hospitalized for COVID-19/MIS-C during March 1, 2020- March 1, 2021.
Results: 276 patients were admitted with COVID -19/MIS-C. Demographic and hemostasis markers for each disease subtype are reported in Table 1. Prolonged prothrombin time was the most common coagulation defect and D-dimer > 5 FEU was more common in MIS-C than COVID-19.
| COVID-19 Disease | MIS-C | |||
|---|---|---|---|---|
| Age years (median; range) | 4 (0-19) | 8 (0-20) | ||
| Race (proportion; %) | White | 137/175 (78.29%) | 71/101 (70.30%) | |
| Black/African American | 26/175 (14.86%) | 24/101 (23.76%) | ||
| Asian | 8/175 (4.57%) | 3/101 (2.97%) | ||
| Other/Not Reported | 4/175 (2.29%) | 3/101 (2.97%) | ||
| Ethnicity (proportion; %) | Hispanic or Latino | 89/175 (50.86%) | 50/101 (49.50%) | |
| Admission Hemostasis Tests (proportion; %) | D-Dimer > 5.00 FEU | 3/67 (4.48%) | 11/68 (16.18%) | |
| Prolonged PT (>15.1 seconds) | 7/58 (12.07%) | 22/51 (43.14%) | ||
| Thrombocytopenia (<150 x103/uL) | 12/146 (8.22%) | 30/82 (36.59%) | ||
Demographic and Hemostasis Markers in Covid-19/MIS-C Patients
There were 13 patients with thrombotic complications (4.71%): 7 deep venous thrombosis (DVT), 4 superficial vein thrombosis, 2 pulmonary embolism (PE), 1 arterial ischemic stroke (AIS), and 1 cerebral sinus vein thrombosis (CSVT). Two patients had >1 type of thrombosis. Four had thrombosis on admission (1 CSVT, 1 AIS, 1 DVT/PE, 1 PE), 8 had central line or ECMO related thrombosis and 1 patient without central line associated thrombosis had sickle cell disease. Clinical descriptors of thrombotic vs. non-thrombotic events were compared (Table 2). MIS-C occurred in 61.54% of patients that developed thrombosis (group also with higher BNP and procalcitonin levels). Prophylactic anticoagulation was given to patients 13 and older or with additional risk factors per our institutional thrombosis risk score. Seven of the 9 patients that developed thrombosis more than 24 hours after hospitalization (77.78%) were receiving prophylaxis. No prophylaxis was given to 185 patients and only 6 of those developed thrombosis (0.03%).
| Thrombotic Complications (N=13) | No Thrombotic Complications (N=263) | |||
|---|---|---|---|---|
| Age years (median; range) | 8 (0-18) | 7 (0-20) | ||
| Disease Type (proportion; %) | Covid-19 | 5/13 (38.46%) | 170/263 (64.64%) | |
| MIS-C | 8/13 (61.54%) | 93/263 (35.36%) | ||
| Clinical Descriptors (proportion; %) | BMI > 24 kg/m2 | 4/13 (30.77%) | 83/263 (31.56%) | |
| Prophylactic Anticoagulation | 7/9 (77.78%) | 84/263 (31.94%) | ||
| Contraceptives | 2/13 (15.38%) | 5/263 (1.90%) | ||
| Laboratory Tests at Admission (proportion; %) | D-Dimer > 5.00 FEU | 1/8 (12.50%) | 13/127 (10.24%) | |
| BNP (pg/ml) (median; range) | N=7 70.50 (10.00-1413.40) |
N=130 22.50 (10.00-2885.60) |
||
| Procalcitonin (ng/ml) (median; range) | N=7 3.39 (0.02-18.11) |
N=210 0.26 (0.02-221.61) |
||
Clinical Descriptors of Covid-19/MIS-C Patients Associated with Thrombosis
Conclusions: Although a direct comparison can not be made to reported pediatric thrombosis in hospitalized patients (0.58%) due to inclusion of patients 18-20 years in our study, our prevalence rate of 4.71% suggests COVID-19/MIS-C should be considered an additional risk factor for pediatric thrombosis.
To cite this abstract in AMA style:
Torres M, Tilley J, Trang M, Schenk A. Thrombotic Complications in Pediatric Patients Hospitalized with COVID-19 Disease or Associated Multisystem Inflammatory Syndrome in Children (MIS-C) [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/thrombotic-complications-in-pediatric-patients-hospitalized-with-covid-19-disease-or-associated-multisystem-inflammatory-syndrome-in-children-mis-c/. Accessed December 11, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/thrombotic-complications-in-pediatric-patients-hospitalized-with-covid-19-disease-or-associated-multisystem-inflammatory-syndrome-in-children-mis-c/