Thromboembolism in children with multisystem inflammatory syndrome: A literature review
Multisystem inﬂammatory syndrome in children (MIS-C) is a hyperinﬂammatory response observed in children several weeks to months after acute infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). On review of all published cases of thromboembolism (TE) as a complication of MIS-C, 33 cases of TE were found with incidence ranging from 1.4% to 6.5%. TE occurred mostly in children aged 12 years and above. One-third of the cases were cerebral infarcts and the remaining cases included intracardiac and radial arterial thromboses, upper and lower extremity deep vein thrombosis, pulmonary embolism, and splenic infarcts. Five were asymptomatic cases and 3/33 (9%) patients (all three with cerebral infarcts) died. To conclude, TE appears to be a signiﬁcant complication of MIS-C caused by SARS-CoV-2 infection, associated with morbidity and/or mortality. Patients ≥12 years are affected more often, and TE occurs despite thromboprophylaxis in some patients. Thromboprophylaxis should be considered in all cases after reviewing the concomitant bleeding risk. Prospective studies are needed to conﬁrm the role of standard-dose thromboprophylaxis and to explore whether higher-dose thromboprophylaxis is required in certain high-risk patients with MIS-C.
Thromboembolism appears to be a significant complication of MIS-C associated with SARS-CoV-2 infection especially in children aged ≥ 12 years. Therefore, consideration of thromboprophylaxis in this age group remains critical.
MIS-C: Multisystem inflammatory syndrome in children; SARS-CoV-2: severe acute respiratory syndrome coronavirus-2; UFH: unfractionated heparin; LMWH: low molecular weight heparin; MCA: middle cerebral artery
1. Menon N.M, Srivaths L.V. Thromboembolism in children with multisystem inflammatory syndrome: a literature review. Pediatr Res. 2022. Available as: https://www.nature.com/articles/s41390-021-01873-0#
MAT-IN-2201306 V1.0 06/22