Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Curr Opin Pediatr. 2022 Jun 1;34(3):261-267. doi: 10.1097/MOP.0000000000001130.
To provide an update regarding what is known about thrombotic events and thromboprophylaxis in critically ill children with SARS-CoV-2 infection.
Pediatric patients with SARS-CoV-2 generally have mild illness; however, intensive care is required in about 20-30% of hospitalized children with COVID-19 and an even higher proportion in those with MIS-C. Increased rates of thrombosis have been observed in adults hospitalized with COVID-19, and clinical trials have attempted to optimize thromboprophylaxis. There is significant variability in the estimated incidence of thrombosis in pediatric patients (0-27%) because of variation in patient populations and study design. Multiple studies demonstrate an increased rate of thrombosis compared with baseline in hospitalized pediatric patients. Few studies have evaluated risk factors for thrombosis, but critical illness, older age, and other known thrombosis risk factors appear to increase the risk. Thromboprophylaxis strategies are inconsistent, with little evidence of efficacy but few reports of major bleeding.
Critically ill children with SARS-CoV-2-related illnesses are at increased risk of thrombosis. Thromboprophylaxis should be considered in select patients with COVID-19 or MIS-C, though the optimal strategy is not yet known. More data is required to guide practice to prevent thrombosis in this population.
提供关于 SARS-CoV-2 感染的危重症患儿血栓形成事件和血栓预防的最新信息。
儿科 SARS-CoV-2 患者通常病情较轻；然而，约 20-30%的 COVID-19 住院患儿和更高比例的 MIS-C 患儿需要重症监护。在 COVID-19 住院成人中观察到血栓形成率增加，临床试验试图优化血栓预防。由于患儿人群和研究设计的差异，儿科患者（0-27%）的血栓发生率估计存在显著差异。多项研究表明，与基线相比，住院儿科患者的血栓形成率增加。很少有研究评估血栓形成的危险因素，但危重症、年龄较大和其他已知的血栓形成危险因素似乎会增加风险。血栓预防策略不一致，虽然很少有疗效证据，但有报道称大出血风险增加。
与 SARS-CoV-2 相关疾病的危重症患儿发生血栓的风险增加。COVID-19 或 MIS-C 患儿中应考虑使用血栓预防，但最佳策略尚不清楚。需要更多数据来指导该人群预防血栓形成的实践。
