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Short report
Prevalence of thrombotic complications in children with SARS-CoV-2
  1. David Aguilera-Alonso1,2,
  2. Sara Murias3,
  3. Amelia Martínez-de-Azagra Garde4,
  4. Antoni Soriano-Arandes,5,
  5. Marta Pareja6,
  6. Enrique Otheo7,
  7. Cinta Moraleda8,9,
  8. Alfredo Tagarro9,10,11,12,
  9. Cristina Calvo13
  10. on behalf of EPICO-AEP Working Group
    1. 1 Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
    2. 2 Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
    3. 3 Pediatric Rheumatology Department, Hospital La Paz, Madrid, Spain
    4. 4 Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
    5. 5 Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Vall d'Hebron, Barcelona, Spain
    6. 6 Department of Pediatrics, Hospital General de Albacete, Albacete, Spain
    7. 7 Department of Pediatrics, Hospital Ramón y Cajal, Madrid, Spain
    8. 8 Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
    9. 9 Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Hospital 12 de Octubre, Madrid, Spain
    10. 10 Pediatrics Department, Hospital Universitario Infanta Sofia, Madrid, Spain
    11. 11 Fundación para la Investigación, Hospital Universitario Infanta Sofía y del Henares, Madrid, Spain
    12. 12 Universidad Europea, Madrid, Spain
    13. 13 Department of Pediatrics, Infectious and Tropical Diseases, Hospital Universitario La Paz, Madrid, Spain
    1. Correspondence to Dr David Aguilera-Alonso, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid 28009, Spain; david.aguilera{at}salud.madrid.org

    Abstract

    Knowledge of thrombosis in children with SARS-CoV-2 is scarce. In this multicentre national cohort of children with SARS-CoV-2 involving 49 hospitals, 4 patients out of 537 infected children developed a thrombotic complication (prevalence of 0.7% (95% CI: 0.2% to 1.9%) out of the global cohort and 1.1% (95% CI: 0.3% to 2.8%) out of the hospitalised patients). We describe their characteristics and review other published paediatric cases. Three out of the four patients were adolescent girls, and only two cases had significant thrombotic risk factors. In this paediatric cohort, D-dimer value was not specific enough to predict thrombotic complications. Adolescence and previous thrombotic risk factors may be considered when initiating anticoagulant prophylaxis on children with SARS-CoV-2 disease (COVID-19).

    • Covid-19
    • epidemiology

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information.

    This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

    https://bmj.com/coronavirus/usage

    https://doi.org/10.1136/archdischild-2020-321351

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      Data availability statement

      All data relevant to the study are included in the article or uploaded as supplemental information.

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      Footnotes

      • Twitter @DavidAguileraAl, @tonisoriano66, @CclavoreyRITIP

      • Correction notice This paper has been updated since it was published online. There has been a change to an author's first name in the EPICO-AEP Working Group.

      • Collaborators EPICO-AEP Working Group: Mar Santos, Marisa Navarro, Jesús Saavedra, Elena Rincón, Begoña Santiago (Hospital Universitario Gregorio Marañón); Pablo Rojo, Daniel Blázquez, Luis Prieto, Elisa Fernández-Cooke, Cristina Epalza, Sara Domínguez-Rodríguez, Serena Villaverde (Hospital 12 de Octubre); María José Mellado, Teresa del Rosal, Carlos Grasa, Paula Rodríguez Molino (Hospital La Paz); Francisco José Sanz-Santaeufemia, José Antonio Alonso Cadenas, Gero Calleja, María Isabel Iglesias Bouzas, Blanca Herrero (Hospital Universitario Niño Jesús); Victoria Fumadó, Miguel Lanaspa; Silvia Simó (Hospital Sant Joan de Déu); Susana Melendo, Pere Soler-Palacin (Hospital Vall d'Hebron); María Urretavizcaya, Mercedes Herranz (Complejo Hospitalario de Navarra); Fátima Ara, Fernando Cabañas (Hospital Universitario Quirónsalud Madrid); Rut del Valle, María Fernández, Teresa Raga, María de la Serna, Ane Plazaola (Hospital Infanta Sofía); María Dolores Martín (BR Salud); Enrique Otheo, José Luis Vázquez (Hospital Ramón y Cajal); Lola Falcón, Olaf Neth, Peter Olbrich, Walter Goicoechea (Hospital Universitario Virgen del Rocío); Laura Martín (Hospital Universitario Regional de Málaga); Lucía Figueroa (Hospital de Villalba); María Llorente (Hospital Universitario del Sureste); María Penn, Claudia García, María García, Teresa Alvaredo (Hospital Príncipe de Asturias); Ma Inmaculada Olmedo, Agustín López (Hospital Puerta de Hierro); Elvira Cobo (Hospital Fundación Alcorcón); Mariam Tovizi (Hospital del Tajo); Pilar Galán (Hospital Fundación Fuenlabrada); Beatriz Soto, Sara Guillén (Hospital de Getafe); Adriana Navas (Hospital Infanta Leonor); M Luz García (Hospital de Leganés); Sara Pérez (Hospital de Torrejón); Amanda Bermejo, Pablo Mendoza (Hospital de Móstoles); Gema Sabrido (Hospital Rey Juan Carlos); María José Hernández (Hospital Central de la Defensa); Ana Belén Jiménez (Fundación Jiménez Díaz); Arantxa Berzosa, Marta Illán (Hospital Clínico San Carlos); Nerea Gallego, Ana López (Hospital Universitari Son Espases); Beatriz Ruiz (Hospital Universitario Reina Sofía); Santiago Alfayate, Ana Menasalvas, Eloísa Cervantes (Hospital Clínico Universitario Virgen de la Arrixaca); María Méndez (Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol); Ángela Hurtado (Instituto Hispalense de Pediatría); Cristina García, Inés Amich, Yolanda Ruiz (Hospital San Pedro); Manuel Oltra, Álvaro Villaroya (Hospital Universitari i Politècnic La Fe); Angustias Ocaña (Hospital La Moraleja); Isabel Romero, María Fernanda Guzmán (Hospitales Madrid); MJ Pascual (Hospital Nisa); María Sánchez-Códez (Hospital Universitario Puerta del Mar); Elena Montesinos (Consorci Hospital General Universitari de València); Julia Jensen, María Rodríguez (Hospital Infanta Cristina); Gloria Caro (Hospital Infanta Elena); Neus Rius, Alba Gómez (Hospital Universitari Sant Joan de Reus); Rafael Bretón (Hospital Clínico Universitario de Valencia); Margarita Rodríguez, Julio Romero (Hospital Universitario Virgen de las Nieves); Ana Campos (Hospital Universitario Sanitas La Zarzuela); Mercedes García (Hospital de Mérida); Rosa María Velasco (Complejo Hospitalario de Toledo); Zulema Lobato (Althaia, Xarxa Assistencial Universitària de Manresa); Fernando Centeno, Elena Pérez (Hospital Universitario Río Hortega); Paula Vidal (Hospital Clínico Universitario Lozano Blesa); Corsino Rey, Ana Vivanco, Maruchi Alonso (Hospital Universitario Central de Asturias); Pedro Alcalá, Javier González de Dios (Hospital General Universitario de Alicante); Eduard Solé, Laura Minguell (Hospital Universitari Arnau de Vilanova); Itziar Astigarraga (Hospital Universitario de Cruces); Ma Ángeles Vázquez, Miguel Sánchez (Hospital Universitario Torrecárdenas); Elena Díaz (Hospital Virgen de la Luz); Eduardo Consuegra (Hospital Universitario de Salamanca); María Cabanillas (Complejo Asistencial Universitario de Palencia); Luis Peña (Hospital Universitario Materno Infantil de las Palmas); Elisa Garrote, Maite Goicoechea (Hospital Universitario de Basurto); Irene Centelles (Hospital General Universitari de Castelló); Santiago Lapeña, Sara Gutiérrez, Soraya Gutiérrez (Complejo Asistencial Universitario de León); Amparo Cavalle (PIUS Hospital de Valls); José María Olmos (Hospital Mare de Déu dels Lliris); Alejandro Cobo, Sara Díaz (Hospital Universitario de Canarias); Beatriz Jiménez (Hospital Universitario Marqués de Valdecilla); Raúl González (Hospital Sant Joan d’Alacant); Miguel Lafuente, Matilde Bustillo (Hospital Infantil de Zaragoza); Natividad Pons, Julia Morata (Hospital Lluís Alcanyis); Elsa Segura (Hospital Universitario Son Llatzer de Palma de Mallorca); and María Bernardino (Universidad Europea de Madrid).

      • Contributors DA-A, CC, CM and AT designed the study. SM, AM-d-A, AS-A, MP and EO did the follow-up of patients with COVID-19 and thrombosis. DA-A and CC drafted the initial manuscript. CM, AT, SM, AM-d-A, AS-A, MP and EO reviewed and edited the manuscript. All authors approved the final version of the manuscript.

      • Funding This study was funded by project PI20/00095, from the Instituto de Salud Carlos III and Fondos FEDER, and partially supported by a grant from the Spanish Society of Pediatrics (AEP). DA-A is funded by the Spanish Ministry of Health–Instituto de Salud Carlos III and co-funded by the European Union (FEDER) (Contrato Río Hortega CM18/00100).

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.