PB0066 - Thromboprophylaxis outcome in childhood SARS-CoV-2 infection: A single-center experience

Background: Background
The SARS-CoV-2 infection has been associated with a potentially severe inflammatory reaction, endothelial damage, and coagulation cascade activation that cause thrombosis.
There is limited information on the thrombosis and anticoagulant therapy in children with COVID-19 and no design pediatric-specific recommendations for thromboprophylaxis in COVID-19 are available.

Aims: This study aims to evaluate the outcome of thromboprophylaxis in children less than 18-year-old with COVID-19 infection.

Methods: A retrospective study was conducted on 184 pediatric patients with confirmed COVID-19 infection in southern Iran. A designed questionnaire was made to collect all demographic, clinical, and laboratory data. According to World Health Organization, the patients were classified as asymptomatic/mild, moderate, severe, and critically ill.

Results: The mean age of the patients was 7.04 ± 5.9 (1 week to < 18 years), 96 boys and 88 girls.
Overall, 33 patients received anticoagulant therapy. The median of D-dimer was insignificantly higher in patients taking anticoagulant therapy compared to another group. (P=0.133). All variables were comparable between the two groups. The mortality rate was non-significantly higher in patients who were not treated with anticoagulants (14%) compared to the thromboprophylaxis group (9%) (P=0.567). In the critical group, two patients were complicated with disseminated intravascular coagulation (2.56%), one patient (1.28%) with deep vein thrombosis despite taking thromboprophylaxis, and one (1.28%) with pulmonary thromboembolism while the patient did not take anticoagulant during hospital admission Table 1).

Conclusion(s): Our data showed a lower rate of thrombosis (1.4% in moderate to severe/critically ill patients) than adult patients with COVID-19 infection. Moreover, higher mortality rate was observed in patients without anticoagulant therapy, though statistically not significant. It may underline the role of anticoagulants in moderate to severe/critically ill children with COVID-19 infection. Expert opinion and personal experience are necessary, while we have a significant knowledge gap in understanding COVID-19-associated coagulopathy and thrombotic risk in children.