From the First Department of Pediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece.
Pediatr Infect Dis J. 2022 Jul 1;41(7):570-574. doi: 10.1097/INF.0000000000003545. Epub 2022 Jun 7.
The incidence and severity of coagulation abnormalities have not been extensively studied in pediatric populations with coronavirus disease 2019 (COVID-19). Moreover, their association with an increased risk for thromboembolic events remains unclear, and there is a lack of evidence for optimal prophylactic antithrombotic management. The aim of our study was to present our experience in evaluation, management, and long-term outcomes of coagulation abnormalities in pediatric hospitalized patients with COVID-19.
A prospective study was performed in all children hospitalized for COVID-19 during a 6-month period focusing on patients' coagulation abnormalities, the normalization of the coagulation profile with or without anticoagulation prophylaxis and the clinical outcome of the disease.
Two hundred twenty-three patients (median age: 11.4 months) were enrolled in the study. Coagulation abnormalities were detected in 92.4% of patients with increased D-dimer levels to be the most common abnormality detected in 84.3% of patients. Prophylactic anticoagulation was initiated only in 7 (3.1%) selected patients with severe COVID-19 and at least 2 risk factors for venous thromboembolism (VTE) and in all patients with previous history of VTE. Follow-up coagulation profile in 85 patients showed that changes over time had a tendency towards normalization irrespectively of the initiation of anticoagulant thromboprophylaxis. No thrombotic complications were observed 3 months upon discharge.
Although abnormal findings in coagulation profile were very common, they were not associated with risk for VTE even in severe cases. A trend of normalization early in the course of the disease was observed regardless of the use of anticoagulant thromboprophylaxis.
在患有 2019 年冠状病毒病（COVID-19）的儿科人群中，尚未广泛研究凝血异常的发生率和严重程度。此外，其与血栓栓塞事件风险增加的关系尚不清楚，并且缺乏最佳预防血栓形成的抗凝管理证据。我们的研究目的是介绍我们在评估、管理和COVID-19 住院患儿凝血异常的长期结果方面的经验。
在 6 个月的时间内，对所有因 COVID-19 住院的儿童进行了一项前瞻性研究，重点关注患者的凝血异常、凝血谱的正常化（有无抗凝预防）以及疾病的临床结果。
共纳入 223 例患儿（中位年龄：11.4 个月）。92.4%的患者存在凝血异常，其中最常见的异常是 D-二聚体水平升高，占 84.3%。仅在 7 例（3.1%）病情严重且至少有 2 个静脉血栓栓塞（VTE）危险因素的 COVID-19 患者和所有有 VTE 病史的患者中启动了预防性抗凝治疗。85 例患者的随访凝血谱显示，无论是否启动抗凝血栓预防，随时间变化，变化均有趋于正常的趋势。出院后 3 个月未观察到血栓并发症。
尽管凝血谱异常发现非常普遍，但即使在严重病例中，也与 VTE 风险无关。在疾病早期，无论是否使用抗凝血栓预防，均观察到正常化的趋势。
