Presentation Details
| COVID-19 Venous Thromboembolism Prophylaxis Guidelines Sara McElroy1, 2, Emily Cramer1, 2, Lauren Amos1, 2. 1Children's Mercy Kansas City, Kansas City, MO, USA.2University of Missouri-Kansas City, Kansas City, MO, USA |
Abstract
Background SARS-CoV-2 (COVID-19) infection and multisystem inflammatory syndrome in children (MIS-C) are established risk factors for venous thromboembolism (VTE) in children. Guidelines for VTE prophylaxis that were established at our institution at the beginning of the pandemic were extrapolated from adult data and recommendations. Patients who had any VTE risk factors in addition to COVID-19 met criteria for initiation of anticoagulation prophylaxis. Patients who were diagnosed with MIS-C met criteria regardless of additional risk factors. Objectives Our primary aim was to determine compliance with the established guidelines for COVID-19 VTE prophylaxis at our institution. Our secondary aim was to determine the incidence of VTE in patients admitted for COVID-19 or MIS-C. We intended to update the guidelines based on our patient outcomes. Methods This was a retrospective review of patients admitted for at least 48 hours to Children’s Mercy Kansas City from March 2020 through February 2022 with COVID-19 or MIS-C. We collected demographic information as well as data on VTE risk factors including prior medical history, ICU status, and presence of a central venous catheter (CVC). We determined if the patient met institutional criteria for VTE prophylaxis and if they were started on VTE prophylaxis. We also collected data on what anticoagulant was administered and whether a VTE occurred. Statistical analysis was performed on the data using chi-square tests and logistic regression models. Results There were 678 patients who met the inclusion criteria. Of these, 573 (84.5%) had COVID-19, and 120 (17.7%) had MIS-C. There were 15 patients diagnosed with both COVID-19 and MIS-C. Among the 519 patients who met criteria for VTE prophylaxis, 348 (65.6%) were started on prophylaxis. The odds of starting prophylaxis were significantly higher in patients with a personal (6.54; CI 2.03-21.05) or family history (6.79; CI 1.55-29.86) of thrombosis or thrombophilia, a diagnosis of MIS-C (19.79; CI 2.30-170.14), admission to the ICU (2.28; CI 1.24-4.18), and a CVC (2.12; CI 1.16-3.86). Eighteen patients developed a VTE. The incidence of VTE in patients who were not on prophylaxis was 1.21% and in patients who were on prophylaxis, was 4.02%. The incidence of VTE in COVID-19 infection alone was 2.5% and in MIS-C, was 3.3%. All patients who developed a VTE met criteria for starting prophylaxis, and 77.8% were on prophylaxis. Most patients were in the ICU (72.2%), had a CVC (77.8%), and were on oxygen supplementation (77.8%). Conclusions We found a moderate level of adherence to the VTE guidelines established at our institution and identified risk factors to provide education about in order to improve adherence in certain high-risk populations. The incidence of VTE in our patients with COVID-19 and MIS-C is similar to VTE rates at other institutions. The higher VTE incidence in patients who were on prophylaxis likely reflects a generally higher risk population. We found that universally recognized VTE risk factors are appropriate to include as risk factors for thrombosis in hospitalized patients with COVID-19 and MIS-C.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.