Consensus-based clinical recommendations and research priorities for anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illness.
Consensus-based clinical recommendations and research priorities for anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illness.
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基于共识的临床建议和研究优先级，用于住院的儿童抗凝血栓预防症，因1909999名相关疾病而住院。
DOI：
10.1111/jth.15073
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发表时间：
2020-11
期刊：
影响因子：
--
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中科院分区：
文献类型：
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观察性研究表明，因 COVID-19 相关疾病住院的儿童与成人一样，发生静脉血栓栓塞 (VTE) 的风险增加。美国最近启动了一项针对因 COVID-19 相关疾病住院的儿童进行抗凝血栓预防的多中心 2 期临床试验。迄今为止，仍然缺乏高质量的证据来指导全世界的临床实践。因此，本科学声明的目的是就因 COVID-19 相关疾病住院的儿童使用抗凝血栓预防提供基于共识的建议，并确定未来研究的重点。我们调查了来自几大洲的 20 名儿科血液学家和儿科重症监护医生，他们被儿科/新生儿止血和血栓形成小组委员会领导层认定为在使用抗凝药物预防血栓和/或治疗儿童 COVID-19 相关疾病方面拥有经验和专业知识。还对儿童 COVID-19 的文献进行了全面回顾。响应率为 90%。基于专家意见共识，我们建议对于因 COVID-19 相关疾病（包括儿童多系统炎症综合征 [MIS-C]）而住院且 D-二聚体水平显着升高或叠加了医院相关临床危险因素的儿童，每天两次皮下注射低剂量低分子量肝素作为抗凝血栓预防（在没有禁忌症的情况下，并在可行的情况下与序贯加压装置的机械血栓预防相结合）。静脉血栓栓塞。对于临床不稳定或有严重肾功能损害的儿童，我们建议通过持续静脉输注使用普通肝素作为抗凝预防血栓的药物。此外，未来研究的几个关键重点还包括继续努力描述 COVID-19 儿童的 VTE 风险和危险因素，以及通过合作多中心试验评估因 COVID-19 相关疾病（包括 MIS-C）住院儿童的抗凝血栓预防策略的安全性和有效性。这些关于在因 COVID-19 相关疾病住院的儿童中使用抗凝剂预防血栓的共识建议以及未来研究的重点将随着高质量证据的出现而更新。
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. 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. 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. 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.
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影响因子：
1.1
作者：
Wang, Yan;Wang, Bo;Hong, Daojun
通讯作者：
Hong, Daojun
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10.4
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Middeldorp, Saskia;Coppens, Michiel;van Es, Nick
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van Es, Nick
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13.3
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Henderson, Lauren A.;Canna, Scott W.;Mehta, Jay J.
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Mehta, Jay J.
影响因子：
10.4
作者：
Branchford, B. R.;Mahajerin, A.;Goldenberg, N. A.
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Goldenberg, N. A.
影响因子：
158.5
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Dufort, Elizabeth M.;Koumans, Emilia H.;Zucker, Howard
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Zucker, Howard