Thrombotic risk in children with COVID-19 infection: A systematic review of the literature.

Abstract

OBJECTIVE:

Coagulation and inflammatory parameters are mildly altered in children with SARS-CoV-2 (COVID-19) infection, and laboratory evidence of a proinflammatory and procoagulant state has been noted in multisystem inflammatory syndrome in children (MIS-C). It is not clear whether this pediatric condition is related to thrombotic events. With this study we reviewed the literature for thrombotic complications in children with COVID-19 infection and MIS-C.

DATA SOURCES:

We searched the Medline PubMed Advanced Search Builder, Scopus, Web Of Science, and Google Scholar electronic databases (until 1 January 2021) using the medical subject headings (MeSH) terms and text words (their combinations and truncated synonyms): (THROMBOSIS OR THROMBOPHILIA) AND (CHILD OR CHILDREN OR INFANT) AND (COVID-19 OR SARS-CoV-2).

STUDY ELIGIBILITY CRITERIA:

Inclusion criteria were children with COVID-19 or SARS-COV-2 infection. The search was limited to articles published in English. Exclusion criteria were: reviews of published studies, studies published only as abstracts, letters or conference proceedings, discussion papers, animal studies, or editorials.

RESULTS:

After screening for duplicates, the initial search yielded 86 records: 12 were case reports involving 19 children; comorbidities were absent or mild in 73.7%. The most common site of thrombosis the lung (21%); the most often used drug was heparin (42%). Two studies were an international survey (n = 337 patients) and a large multicenter study (n = 186 patients with MIS-C). The risk of ischemic stroke in SARS-CoV-2 infection (0.82%) and deep venous thrombosis in MIS-C (4.3%) was lower in children than in adults.

CONCLUSIONS:

Thrombodic or thromboembolic events are rare in pediatric patients with COVID-19 infection and MIS-C. Nonetheless, as in adults, a high index of suspicion should be maintained in children with COVID-19 infection or MIS-C, particularly in those with comorbidities predisposing to thrombotic events.

• Authors: Marco Zaffanello, Giorgio Piacentini, Luana Nosetti, Stefania Ganzarolli, Massimo Franchini
• Journal: Thrombosis research (Thromb Res) Vol. 205 Pg. 92-98 (09 2021) ISSN: 1879-2472 [Electronic] United States
• PMID: 34293539 (Publication Type: Journal Article, Review, Systematic Review)
• Copyright: Copyright © 2021 Elsevier Ltd. All rights reserved.

Topics

• Adult
• COVID-19
• Child
• Humans
• Infant
• Multicenter Studies as Topic
• SARS-CoV-2
• Systemic Inflammatory Response Syndrome
• Thrombosis (etiology)