433 CMAAO CORONA FACTS and MYTH 29th Thrombosis in children
Dr K K Aggarwal
433 CMAAO CORONA FACTS and MYTH 29th Thrombosis in children
Dr K Aggarwal President CMAAO, HCFI
With input from Dr Monica Vasudev
1575:
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New York Times Excerpts: Is a variant to blame for India’s Covid crisis? |
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Doctors, the public and the news media in India point to a so-called “double mutant” coronavirus variant — both more contagious and more resistant to vaccines — as the explanation for skyrocketing cases. Scientists say the data is too thin, and cite other possible reasons behind the country’s second wave. |
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India’s worries have focused on a homegrown variant called B.1.617. But researchers outside of India say the better-known B.1.1.7 variant, which walloped Britain late last year and is now the most common source of new infection in the U.S., may be a more considerable factor. It is now rising quickly in New Delhi. |
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More obvious factors could also explain the viciousness of the outbreak. Less than two percent of Indians are fully vaccinated. After the first wave, people relaxed their public behavior. |
DG Alert excerpts
1576: Study details incidence of thrombosis in children and adolescents hospitalised with COVID-19 or MIS-C
A multicentre retrospective cohort study was conducted to determine the incidence of thrombosis in children and adolescents hospitalised with coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) and to evaluate its associated risk factors. The findings were published in Blood.
Between March 1 to August 15, 2020, 853 hospital admissions were identified in 814 patients with a positive COVID-19 polymerase chain reaction (PCR) test or a diagnosis of MIS-C across 7 pediatric hospitals in 6 US states. Of the admissions, 426 (50%) were for symptomatic COVID-19, 138 (16%) were for MIS-C, and 289 (34%) were for asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Overall, there were 21 thrombotic events.
Patients with MIS-C were reported to have the highest incidence of thrombotic events (6.5%), followed by those with symptomatic COVID-19 (2.1%), compared to an incidence rate of 0.7% among patients with asymptomatic SARS-CoV-2 infection. Of the 19 thrombotic events in patients with symptomatic COVID-19 or MIS-C, 11 were deep vein thrombosis, 3 were pulmonary embolism, 3 were intracardiac thrombosis, 1 was acute ischemic stroke, and 1 was cerebral sinovenous thrombosis.
Among patients with symptomatic COVID-19 or MIS-C, the majority of thrombotic events (89%) occurred in patients ≥12 years, whereby the incidence of thrombotic events was 6.8% in patients with symptomatic COVID-19 or MIS-C ≥ 12 years, compared to 0.6% in those <12 years.
Further, anticoagulant thromboprophylaxis was used during 30% of symptomatic COVID-19 and 58% of MIS-C admissions in those patients. Nonetheless, the researchers found that 71% of thrombotic events that were not present on admission occurred despite thromboprophylaxis.
Multivariable analysis revealed that age ≥12 years (odds ratio [OR] 16.84, 95% confidence interval [CI] 1.93-147.1, P = 0.011), cancer (OR 6.34, 95% CI 1.56-25.73, P = 0.01), presence of a central venous catheter (OR 7.22, 95% 1.71-30.45, P = 0.007) , and MIS-C (OR 6.44, 95% CI 1.65-25.24, P = 0.008) were significantly associated with the incidence of thrombosis.
With regard to mortality, the rate was 2.3% among patients with symptomatic COVID-19 or MIS-C, with a higher mortality rate of 28% being reported in patients with symptomatic COVID-19 or MIS-C and thrombotic events.
To put our findings into perspective, the rate of venous thromboembolism in children admitted to US tertiary care hospitals in 2007 was estimated at 58 per 10,000 admissions (0.58%) using the Pediatric Health Information System (PHIS) database, with those ages 12-18 years having the highest rate (94 per 10,000; 0.94%). The rate observed in our study is much higher, particularly in patients ≥12 years (6.8%) with [symptomatic] COVID-19 or MIS-C.
The rates of thrombotic events observed in the study, particularly in the MIS-C population and those ≥12 years of age, suggest that symptomatic COVID-19 and MIS-C are unique risk factors for thrombosis in hospitalised children, despite the facts that patients hospitalised with symptomatic COVID-19 are known to have a high prevalence of underlying medical conditions and that the age distribution of patients in this study is skewed toward older patients compared to the PHIS [database].
The findings, including the low rate of thrombotic events in children < 12 years with [symptomatic] COVID-19 or MIS-C ... along with factors associated with an increased risk (age ≥ 12 years, MIS-C, central venous catheter, and cancer) may help inform thromboprophylaxis strategies at pediatric centers.
Future studies focused on the intensity of anticoagulation as well as at novel targets, are well underway in adults with COVID-19, and will likely be relevant to high-risk adolescent patients with COVID-19 and MIS-C, in whom the rate of thrombosis and mortality rate were highest.