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Thrombotic events in children and adolescent patients with SARS-Cov-2 infection: a systematic review with meta-analysis on incidence and management

Unit of Pediatrics and Pediatric Emergency, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco, San Marco Hospital, Via Azeglio Ciampi, 95100, Catania, Italy. Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco, San Marco Hospital, San Marco Hospital, Via Azeglio Ciampi, 95100, Catania, Italy. Post graduate program in Pediatric, Department of Clinical and Experimental Medicine, University of Catania, Italy. Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, 95124, Catania, Italy.

Expert review of hematology. 2022
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Abstract
OBJECTIVES the present paper aimed to study available literature on the hypercoagulability state of pediatric patients affected by COVID-19, and the current management of thrombosis in these patients, considering that no guidelines have been published since now in this age group. METHODS N 244 titles were screened using the selected MESH words, 180 abstracts and 120 full texts were read, 12 articles were included, and four were analysed by meta-analysis. RESULTS Over 1128 COVID-19 positive patients, nearly half of them developed inflammatory sequelae, and 7.35% (40 patients over 544 who developed MIS-C) had thrombotic events. Less than 50% of patients with inflammatory disease were under anticoagulant prophylactic treatment, and doses of anticoagulant protocols vary from different centres. Thrombotic events prevented after the start of unfractioned heparin (UFH) therapy, even if 1.06% (4 patients) died. Only two patients presented complications after anticoagulant treatment, with non-fatal bleeding after UFH treatment. No other complications were reported. No difference in the incidence of thrombotic events between patients under prophylactic low molecular weight heparin (LMWH) and without was found in meta-analysis (p=0.32). CONCLUSIONS Little is known on the incidence and management of hyper coagulopathy in pediatric COVID-19 infection. Further studies have to clarify this topic.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine