Neil A Goldenberg1,2, Anthony Sochet2,3, Manuela Albisetti4, Tina Biss5, Mariana Bonduel6, Julie Jaffray7, Graeme MacLaren8,9, Paul Monagle10,11,12, Sarah O'Brien13, Leslie Raffini14, Shoshana Revel-Vilk15, Nongnuch Sirachainan16, Suzan Williams17, Ayesha Zia18, Christoph Male19. 1. Divisions of Hematology, Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Johns Hopkins All Children's Hospital and Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA. 3. Division of Pediatric Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 4. Division of Hematology, University Children's Hospital of Zurich, Zurich, Switzerland. 5. Department of Haematology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. 6. Servicio de Hematología-Oncología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina. 7. Division of Hematology/Oncology, Department of Pediatrics, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, CA, USA. 8. Division of Critical Care, Department of Pediatrics, University of Melbourne and Royal Children's Hospital, Melbourne, Vic., Australia. 9. Division of Critical Care, National University Hospital, Singapore City, Singapore. 10. Department of Pediatrics, University of Melbourne, Melbourne, Vic., Australia. 11. Department of Haematology, Royal Children's Hospital, Melbourne, Vic., Australia. 12. Haematology Research, Murdoch Children's Research Institute, Melbourne, Vic., Australia. 13. Division of Hematology/Oncology, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA. 14. Division of Hematology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 15. Pediatric Hematology/Oncology Unit, Department of Pediatrics, Hebrew University Medical School and Shaare Zedek Medical Center, Jerusalem, Israel. 16. Division of Hematology/Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 17. Division of Hematology/Oncology, Department of Pediatrics, University of Toronto Faculty of Medicine and Hospital for Sick Children, Toronto, ON, Canada. 18. Division of Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern School of Medicine, Dallas, TX, USA. 19. Division of Cardiology, Department of Pediatrics, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: Observational studies indicate that children hospitalized with COVID-19-related illness, like adults, are at increased risk for venous thromboembolism (VTE). A multicenter phase 2 clinical trial of anticoagulant thromboprophylaxis in children hospitalized with COVID-19-related illness has recently been initiated in the United States. To date, there remains a paucity of high-quality evidence to inform clinical practice world-wide. Therefore, the objective of this scientific statement is to provide consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses, and to identify priorities for future research. METHODS: We surveyed 20 pediatric hematologists and pediatric critical care physicians from several continents who were identified by Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee leadership as having experience and expertise in the use of anticoagulant thromboprophylaxis and/or the management of COVID-19-related illness in children. A comprehensive review of the literature on COVID-19 in children was also performed. RESULTS: Response rate was 90%. Based on consensus of expert opinions, we suggest the administration of low-dose low molecular weight heparin subcutaneously twice-daily as anticoagulant thromboprophylaxis (in the absence of contraindications, and in combination with mechanical thromboprophylaxis with sequential compression devices, where feasible) in children hospitalized for COVID-19-related illness (including the multisystem inflammatory syndrome in children [MIS-C]) who have markedly elevated D-dimer levels or superimposed clinical risk factors for hospitalassociated VTE. For children who are clinically unstable or have severe renal impairment, we suggest the use of unfractionated heparin by continuous intravenous infusion as anticoagulant thromboprophylaxis. In addition, continued efforts to characterize VTE risk and risk factors in children with COVID-19, as well as to evaluate the safety and efficacy of anticoagulant thromboprophylaxis strategies in children hospitalized with COVID-19-related illness (including MIS-C) via cooperative multicenter trials, were identified among several key priorities for future research. CONCLUSION: These consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses and priorities for future research will be updated as high-quality evidence emerges.
BACKGROUND: Observational studies indicate that children hospitalized with COVID-19-related illness, like adults, are at increased risk for venous thromboembolism (VTE). A multicenter phase 2 clinical trial of anticoagulant thromboprophylaxis in children hospitalized with COVID-19-related illness has recently been initiated in the United States. To date, there remains a paucity of high-quality evidence to inform clinical practice world-wide. Therefore, the objective of this scientific statement is to provide consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses, and to identify priorities for future research. METHODS: We surveyed 20 pediatric hematologists and pediatric critical care physicians from several continents who were identified by Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee leadership as having experience and expertise in the use of anticoagulant thromboprophylaxis and/or the management of COVID-19-related illness in children. A comprehensive review of the literature on COVID-19 in children was also performed. RESULTS: Response rate was 90%. Based on consensus of expert opinions, we suggest the administration of low-dose low molecular weight heparin subcutaneously twice-daily as anticoagulant thromboprophylaxis (in the absence of contraindications, and in combination with mechanical thromboprophylaxis with sequential compression devices, where feasible) in children hospitalized for COVID-19-related illness (including the multisystem inflammatory syndrome in children [MIS-C]) who have markedly elevated D-dimer levels or superimposed clinical risk factors for hospitalassociated VTE. For children who are clinically unstable or have severe renal impairment, we suggest the use of unfractionated heparin by continuous intravenous infusion as anticoagulant thromboprophylaxis. In addition, continued efforts to characterize VTE risk and risk factors in children with COVID-19, as well as to evaluate the safety and efficacy of anticoagulant thromboprophylaxis strategies in children hospitalized with COVID-19-related illness (including MIS-C) via cooperative multicenter trials, were identified among several key priorities for future research. CONCLUSION: These consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses and priorities for future research will be updated as high-quality evidence emerges.
Authors: Alison A Lopez; Mona Patel; Jonathan H Rayment; Herman Tam; Ashley Roberts; Samara Laskin; Lori Tucker; Catherine M Biggs Journal: Paediatr Child Health Date: 2022-09-08 Impact factor: 2.600
Authors: Julianne E Burns; Cary Thurm; James W Antoon; Carlos G Grijalva; Matt Hall; Adam L Hersh; Gabrielle Z Hester; Emilie Korn; Mario A Reyes; Samir S Shah; Balagangadhar R Totapally; Ronald J Teufel Journal: Pediatrics Date: 2022-09-01 Impact factor: 9.703