The Trilogy of SARS-CoV-2 in Pediatrics (Part 3): Thrombosis, Anticoagulant, and Antiplatelet Considerations

The hypercoagulable state induced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects all patients regardless of age. The incidence of venous thromboembolism in pediatric patients with SARS-CoV-2--related illnesses is not well established. Although deep vein thrombosis is rare in children in the absence of risk factors, coagulopathy and the development of thromboses have been described in pediatric patients with acute COVID-19 and multisystem inflammatory syndrome. This comprehensive review provides a detailed overview of SARS-CoV-2--associated coagulopathy as well as strategies for optimizing the evaluation, management, and prevention of thrombosis in pediatric patients. ABBREVIATIONS ACE2, angiotensin-converting enzyme 2;anti-Xa, anti--factor Xa;aPTT, activated partial thromboplastin time;ASA, aspirin;AT-I, angiotensin-I;AT-II, angiotensin-II;BMI, body mass index;CAA, coronary artery aneurysm;CDC, Centers for Disease Control and Prevention;COVID-19, coronavirus disease 2019;DVT, deep vein thrombosis;FDA, US Food and Drug Administration;IL, interleukin;IV, intravenous;KD, Kawasaki disease;LMWH, low molecular weight heparin;MIS-C, multisystem inflammatory syndrome in children;NSAID, nonsteroidal anti-inflammatory agents;PE, pulmonary embolism;PT, prothrombin time;PTT, partial thromboplastin time;SARS-CoV-2, severe acute respiratory syndrome coronavirus 2;SQ, subcutaneous;TF, tissue factor;UFH, unfractionated heparin;ULN, upper limit of normal;VTE, venous thromboembolism [ABSTRACT FROM AUTHOR] Copyright of Journal of Pediatric Pharmacology & Therapeutics is the property of Pediatric Pharmacy Advocacy Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)