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Blood . Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C

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  • Blood . Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C


    Blood


    . 2021 Apr 25;blood.2020010218.
    doi: 10.1182/blood.2020010218. Online ahead of print.
    Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C


    Hilary Baker Whitworth 1 , Sarah E Sartain 2 , Riten Kumar 3 , Katherine Armstrong 4 , Lance Ballester 1 , Marisol Betensky 5 , Clay Cohen 2 , Rosa Diaz 6 , Caroline Diorio 1 , Neil A Goldenberg 7 , Julie Jaffray 8 , Jacquelyn Keegan 8 , Kendra Malone 9 , Adrienne Randolph 3 , Stacey Rifkin-Zeneberg 10 , Wendy Seto Leung 8 , Anthony Alexander Sochet 11 , Lakshmi Srivaths 12 , Ayesha Zia 13 , Leslie Raffini 1



    Affiliations

    Abstract

    Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with thrombotic complications in adults, but the incidence of COVID-19 related thrombosis in children and adolescents is unclear. Most children with acute COVID-19 have mild disease, but coagulopathy has been associated with multisystem inflammatory syndrome in children (MIS-C), a post-infectious complication. We conducted a multicenter retrospective cohort study to determine the incidence of thrombosis in children hospitalized with COVID-19 or MIS-C and to evaluate associated risk factors. We classified patients into one of three groups for analysis: COVID-19, MIS-C, or asymptomatic SARS-CoV-2. Among a total of 853 admissions (426 COVID-19, 138 MIS-C, and 289 asymptomatic SARS-CoV-2) in 814 patients, there were 20 patients with thrombotic events (TE) (including 1 stroke). Patients with MIS-C had the highest incidence (6.5%, 9/138) versus COVID-19 (2.1%, 9/426) or asymptomatic SARS-CoV-2 (0.7%, 2/289). In patients with COVID-19 or MIS-C, the majority of thrombotic events (89%) occurred in patients ?12 years. Patients > 12 years with MIS-C had the highest rate of thrombosis at 19% (9/48). Notably, 71% of TE that were not present on admission occurred despite thromboprophylaxis. Multivariable analysis identified the following as significantly associated with thrombosis: age ?12 years, cancer, presence of a central venous catheter, and MIS-C. In patients with COVID-19 or MIS-C, hospital mortality was 2.3% (13/564), but was 28% (5/18) in patients with thrombotic events. Our findings may help inform pediatric thromboprophylaxis strategies.


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