Antithrombotic prophylaxis in children and adolescent patients with SARS-CoV-2 (COVID-19) infection: A practical guidance for clinicians

Mehran  Karimi; Haleh  Bozorgi; Tahereh  Zarei; Mohammadreza  Bordbar; Ali Amanati; Arash  Safaei; Vincenzo  De Sanctis

doi:10.23750/abm.v91i4.10720

Antithrombotic prophylaxis in children and adolescent patients with SARS-CoV-2 (COVID-19) infection: A practical guidance for clinicians

Authors

Mehran Karimi Hematology Research Center, Shiraz University of Medical Sciences, Shiraz
Haleh Bozorgi Hematology Research Center, Shiraz University of Medical Sciences, Shiraz
Tahereh Zarei Hematology Research Center, Shiraz University of Medical Sciences, Shiraz
Mohammadreza Bordbar Hematology Research Center, Shiraz University of Medical Sciences, Shiraz
Ali Amanati Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Arash Safaei Hematology Research Center, Shiraz University of Medical Sciences, Shiraz
Vincenzo De Sanctis Coordinator of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A), Ferrara, Italy

DOI: https://doi.org/10.23750/abm.v91i4.10720

Keywords:

SARS-Corona-Virus-2, COVID-19, venous thromboembolism, anticoagulation chemoprophylaxis, pediatric ‎

Abstract

Severe coronavirus disease 2019 (COVID-19) is often associated with features of hypercoagulable state which can manifest as venous thromboembolism (VTE) and/or microthrombosis. Given the high risk of VTE in critically ill COVID-19 patients, appropriate VTE prophylaxis seems to be an important part of managing these patients. Although many protocols regarding venous thromboembolism (VTE) prophylaxis or therapeutic (full-dose) anticoagulation have been conducted worldwide, primarily in hospitalised adult patients, details on paediatric patients, if included, are limited or incomplete. The current evidences suggest that anticoagulation therapy with low molecular weight heparins (LMWH) appears to be associated with better prognosis in patients with moderate to severe COVID-19 induced coagulopathies or elevated D-dimer levels. Our recommendations are intended to offer guidance for anticoagulation prophylaxis and treatment in COVID-19 children and adolescent patients and not intend to supersede the clinician judgement. We are also conscious that several clinical questions deserve further studies and clarifications because this area is rapidly evolving.

References

World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard: WHO; 2020 [updated Data last updated: 2020/9/10. Available from: https://covid19.who.int/.

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323:1239-1242.

Shahriarirad R, Khodamoradi Z, Erfani A, et al. Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran. BMC Infect Dis. 2020 Jun 18;20(1):427. doi: 10.1186/s12879-020-05128-x.

Tian S, Hu N, Lou J, wt al. Characteristics of COVID-19 infection in Beijing. J Inf Secur. 2020;80:

–406.

Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020; 323:1061–1069.

Klok FA, Kruip MJHA, van der Meer NJM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis.

Thromb Res. 2020;191:148-150.

Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020;18:1559-1561.

Bikdeli B, Madhavan MV, Jimenez D, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75:2950-2973.

Llau JV, Ferrandis R, Sierra P, et al. SEDAR-SEMICYUC consensus recommendations on the management of haemostasis disorders in severely ill patients with COVID-19 infection. Rev Esp Anestesiol Reanim. 2020 ;67:391-399.

Casini A, Alberio L, Angelillo-Scherrer A, et al. Thromboprophylaxis and laboratory monitoring for in-hospital patients with COVID-19 - a Swiss consensus statement by the Working Party Hemostasis. Swiss Med Wkly. 2020 Apr 11;150:w20247. doi: 10.4414/smw.2020.20247. PMID: 32277760.

Vazquez FJ, Korin J, Baldessari EM, et al. Recommendations for the use of thromboprophylaxis in hospitalized patients with COVID-19 in Argentina. Medicina (B Aires). 2020;80 (Suppl) 3:65-66.

Spyropoulos AC, Levy JH, Ageno W, et al. Scientific and Standardization Committee communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 202018:1859-1865.

Ramacciotti E, Macedo AS, Biagioni RB, et al. Evidence-Based Practical Guidance for the Antithrombotic Management in Patients With Coronavirus Disease (COVID-19) in 2020. Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620936350. doi: 10.1177/1076029620936350.

American Society of Hematology. https://www.hematology.org/covid- 19/covid-19-and-coagulopathy. http://www.hematology.orgcovidcovid- and-coagulopathy. Accessed May 5, 2020.

Song J-C,Wang G, ZhangW, Zhang Y, Li W-Q, Zhou Z. Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19. Mil Med Res. 2020;7(1):19. doi: 10.1186/s40779-020-00247-7.

BSH Haemostatis and Thrombosis Task Force. https://b-s-h.org.uk/ media/18206/dic-score-in-covid-19-pneumonia_01-04-2020.pdf.Accessed May 5, 2020:1-2.

Alhazzani W, Al-Suwaidan FA, Al Aseri ZA, et al. The Saudi Critical Care Society Clinical Practice Guidelines on the management of COVID‑19 patients in the intensive care unit. Saudi Crit Care J. 2020; 4:27-44.

Loi M, Branchford B, Kim J, Self C, Nuss R. COVID-19 anticoagulation recommendations in children. Pediatr Blood Cancer. 2020 Jun 18:e28485. doi: 10.1002/pbc.28485.

Barnes GD, Burnett A, Allen A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020;50:72-81.

Ávila-Castro D, Ortiz-Torres G, Sánchez-Jara B, et al. Proposal for the management of COVID-19-associated coagulopathy in children. Gac Med Mex. 2020;156:344-353.

Oudkerk M, Buller HR, Kuijpers D, et al. Diagnosis, prevention, and treatment of thromboembolic complications in COVID-19: report of the National Institute for Public Health of the Netherlands.

Radiology.2020;297:E216-E222.

Gupta N, Wish JB. Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors: a Potential New Treatment for Anemia in Patients With CKD. Am J Kidney Dis. 2017;69:815–26.

Zhang H, Wang CY, Zhou P, Yue H, Du R. Histopathologic Changes and SARS-CoV-2 Immunostaining in the Lung of a Patient With COVID-19. Ann Intern Med. 2020 Aug 18;173(4):324. doi: 10.7326/L20-0895.

Thachil J, Cushman M, Srivastava A. A proposal for staging COVID-19 coagulopathy. Res Pract Thromb Haemost. 2020;4:731-736.

Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18:1023-1026.

Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin Chim Acta 2020; 506:145–148.

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18:844–847.

Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID- 19: a prospective cohort study. Ann Intern Med. 2020;173:268-277.

Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol. 2020 Jun 16;75(23):2950-2973.

Fox SE, Akmatbekov A, Harbert JL, Li G, Brown JQ. Vander Heide RS. Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans. medRxiv 2020.04.06.20050575; doi: https://doi.org/10.1101/2020.04.06.20050575.

Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5:811-818.

Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020 Jun;145(6):e20200702. doi: 10.1542/peds.2020-0702.

Chen Z, Fu J, Shu Q Chen Y, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr. 2020;16:240-246.

Zhu L, Wang J, Huang R, et al. Clinical characteristics of a case series of children with coronavirus disease 2019. Pediatr Pulmonol. 2020;55:1430–1432.

Moores LK, Tritschler T, Brosnahan S, et al. Prevention, Diagnosis, and Treatment of VTE in Patients With COVID-19: CHEST Guideline and Expert Panel Report. Chest. Chest. 2020;158: 1143-116.