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

Hilary Whitworth, Sarah E. Sartain, Riten Kumar, Katherine Armstrong, Lance Ballester, Marisol Betensky, Clay T. Cohen, Rosa Diaz, Caroline Diorio, Neil A. Goldenberg, Julie Jaffray, Jacquelyn Keegan, Kendra Malone, Adrienne G. Randolph, Stacey Rifkin-Zenenberg, Wendy Seto Leung, Anthony Sochet, Lakshmi Srivaths, Ayesha Zia, Leslie Raffini

Research output: Contribution to journalArticlepeer-review

50 Scopus citations

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 postinfectious complication. We conducted a multicenter retrospective cohort study to determine the incidence of thrombosis in children hospitalized with COVID-19 or MIS-C and evaluate associated risk factors. We classified patients into 1 of 3 groups for analysis: COVID-19, MIS-C, or asymptomatic SARS-CoV-2. Among a total of 853 admissions (COVID-19, n = 426; MIS-C, n = 138; and asymptomatic SARS-CoV-2, n = 289) in 814 patients, there were 20 patients with thrombotic events (TEs; including 1 stroke). Patients with MIS-C had the highest incidence (9 [6.5%] of 138) vs COVID-19 (9 [2.1%] of 426) or asymptomatic SARS-CoV-2 (2 [0.7%] of 289). In patients with COVID-19 or MIS-C, a majority of TEs (89%) occurred in patients age ≥12 years. Patients age ≥12 years with MIS-C had the highest rate of thrombosis at 19% (9 of 48). Notably, 71% of TEs 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 of 564), but it was 28% (5 of 18) in patients with TEs. Our findings may help inform pediatric thromboprophylaxis strategies.

Original languageEnglish (US)
Pages (from-to)190-198
Number of pages9
JournalBlood
Volume138
Issue number2
DOIs
StatePublished - Jul 15 2021

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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