Efficacy of Thromboprophylaxis in Preventing Thrombotic Events in Pediatric Patients With COVID-19 or Multisystem Inflammatory Syndrome: A Systematic Review
Notice bibliographique
Résumé
The COVID-19 pandemic has been associated with a broad spectrum of clinical manifestations, including multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition characterized by a proinflammatory and hypercoagulable state. MIS-C has been linked to an elevated risk of venous thromboembolism (VTE), necessitating a focus on thromboprophylaxis to prevent potentially fatal complications in pediatric patients. This systematic review aims to evaluate the association between COVID-19/MIS-C and thromboembolism and to assess the efficacy of thromboprophylaxis protocols in reducing thrombotic events and mortality in children. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Literature searches were performed in PubMed, Cochrane, and Science Direct databases. Randomized controlled trials, cohort studies, and case-control studies reporting on thromboprophylaxis, thrombotic events, and associated outcomes in pediatric patients (<21 years) with COVID-19 and/or MIS-C were included. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Primary outcomes were the incidence of thrombotic events and mortality, while secondary outcomes included bleeding events, clinical recovery, and changes in coagulation markers. Of the 375 articles identified, three studies (n=771 patients) met the inclusion criteria. Thromboprophylaxis protocols primarily included low molecular weight heparin (LMWH) such as enoxaparin and antiplatelet agents such as aspirin, with varied doses and treatment durations. Thrombotic events were reported in 3.3% of patients, with a higher incidence in MIS-C cases compared to COVID-19 alone. Prophylactic anticoagulation was effective in preventing thrombotic events in high-risk patients without increasing the risk of major bleeding. The studies emphasized individualized treatment approaches based on risk factors such as elevated D-dimer levels, obesity, prolonged immobilization, and central venous catheter presence. All studies reported a low mortality rate, ranging from 0% to 2.2%, highlighting the potential benefit of thromboprophylaxis in this population. Pediatric patients with MIS-C or severe COVID-19 are at an increased risk of thrombotic complications due to their heightened proinflammatory and hypercoagulable states. Thromboprophylaxis using enoxaparin and aspirin appears effective in reducing thrombotic events and mortality in these patients. Individualized protocols based on clinical risk factors and D-dimer levels are critical to optimizing outcomes while minimizing bleeding risks. Standardized, evidence-based guidelines are needed to refine thromboprophylaxis strategies and determine the optimal duration of therapy in this vulnerable population. Further research is essential to better understand the role of coagulation markers in guiding treatment cessation and improving outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,022 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,009 | 0,009 |
| Bibliométrie | 0,006 | 0,006 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».