SARS-COV-2-associated coagulopathy and thromboembolism prophylaxis in children: A single-center observational study.
SARS-COV-2-associated coagulopathy and thromboembolism prophylaxis in children: A single-center observational study.
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DOI：
10.1111/jth.15216
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发表时间：
2021-02
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影响因子：
--
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中科院分区：
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多名研究人员已经描述了SARS-CoV-2感染者血栓栓子事件的发生率增加。关于因新冠肺炎/儿童多系统炎症综合征(MSC)住院的儿童止血并发症的数据很少。分享我们在处理住院儿童SARS-CoV-2相关促凝状态方面的经验。对因SARS-CoV-2相关症状住院的儿童在确诊时记录D-二聚体的值。在中、危重患者和MISC患者中，在多个时间点检测凝血和炎症标志物，并比较结果的中位数。对每个儿童的血栓形成危险因素进行评估，并在选定的病例中开始血栓预防。35名患者被前瞻性纳入研究。D-二聚体的值不能区分不同严重程度的新冠肺炎，而新冠肺炎组和MI-C组之间有显著差异。在两个队列中，D-二聚体和C-反应蛋白水平在临床恶化时升高，但没有伴随纤维蛋白原或血小板数值的下降，所有参数在疾病缓解后恢复正常。6名患者有多种血栓形成危险因素，并开始进行药物血栓预防。无死亡、血栓形成或出血并发症发生。新冠肺炎儿科患者出现轻微的凝血和炎症参数改变；另一方面，MISC患者显示出炎症驱动的促凝状态的实验室迹象。对有SARS-CoV-2相关症状的住院儿童进行普遍的抗凝预防是没有根据的，但可以在多模式治疗方法的背景下提供给有其他血栓形成危险因素的患者。
Multiple investigators have described an increased incidence of thromboembolic events in SARS‐CoV‐2–infected individuals. Data concerning hemostatic complications in children hospitalized for COVID‐19/multisystem inflammatory syndrome in children (MIS‐C) are scant. To share our experience in managing SARS‐CoV‐2–associated pro‐coagulant state in hospitalized children. D‐dimer values were recorded at diagnosis in children hospitalized for SARS‐CoV‐2–related manifestations. In moderately to critically ill patients and MIS‐C cases, coagulation and inflammatory markers were checked at multiple time points and median results were compared. Pro‐thrombotic risk factors were appraised for each child and thromboprophylaxis was started in selected cases. Thirty‐five patients were prospectively enrolled. D‐dimer values did not discriminate COVID‐19 of differing severity, whereas were markedly different between the COVID‐19 and the MIS‐C cohorts. In both cohorts, D‐dimer and C‐reactive protein levels increased upon clinical worsening but were not accompanied by decreased fibrinogen or platelet values, with all parameters returning to normal upon disease resolution. Six patients had multiple thrombotic risk factors and were started on pharmacological thromboprophylaxis. No deaths or thrombotic or bleeding complications occurred. COVID‐19 pediatric patients show mildly altered coagulation and inflammatory parameters; on the other hand, MIS‐C cases showed laboratory signs of an inflammatory driven pro‐coagulant status. Universal anticoagulant prophylaxis in hospitalized children with SARS‐CoV‐2–related manifestations is not warranted, but may be offered to patients with other pro‐thrombotic risk factors in the context of a multi‐modal therapeutic approach.
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