Divisions of Hematology, Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins All Children's Hospital and Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA.
J Thromb Haemost. 2020 Nov;18(11):3099-3105. doi: 10.1111/jth.15073.
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.
观察性研究表明，与成年人一样，因 COVID-19 相关疾病住院的儿童发生静脉血栓栓塞症（VTE）的风险增加。美国最近启动了一项针对 COVID-19 相关疾病住院儿童进行抗凝血栓预防的多中心 2 期临床试验。迄今为止，全球范围内仍缺乏高质量证据来指导临床实践。因此，本科学声明的目的是就 COVID-19 相关疾病住院儿童使用抗凝血栓预防提出基于共识的建议，并确定未来研究的优先事项。
我们调查了来自多个大洲的 20 名儿科血液病学家和儿科重症监护医生，他们是由儿科/新生儿止血和血栓形成小组委员会领导确定的，这些医生在使用抗凝血栓预防和/或管理 COVID-19 相关疾病方面具有经验和专业知识儿童。还对儿童 COVID-19 的文献进行了全面回顾。
回复率为 90%。根据专家意见的共识，我们建议在 COVID-19 相关疾病（包括儿童多系统炎症综合征[MIS-C]）住院的儿童中，如果存在明显升高的 D-二聚体水平或叠加有医院相关 VTE 的临床危险因素，则给予低剂量皮下低分子肝素每日两次作为抗凝血栓预防（在无禁忌症的情况下，并在可行的情况下与序贯压缩装置联合使用机械血栓预防）。对于临床不稳定或有严重肾功能损害的儿童，建议使用连续静脉输注普通肝素作为抗凝血栓预防。此外，还确定了其他一些关键的优先事项，包括继续努力描述 COVID-19 患儿的 VTE 风险和危险因素，以及通过合作多中心试验评估 COVID-19 相关疾病住院患儿（包括 MIS-C）使用抗凝血栓预防策略的安全性和疗效。
这些基于共识的建议和未来研究的优先事项将在高质量证据出现时更新 COVID-19 相关疾病住院儿童使用抗凝血栓预防的建议。
