Children and young adults hospitalized for severe COVID-19 exhibit thrombotic coagulopathy

William B. Mitchell, Jennifer Davila, Janine Keenan, Jenai Jackson, Adit Tal, Kerry A. Morrone, Ellen J. Silver, Sarah O'Brien, Deepa Manwani

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


We report the clinical and laboratory coagulation characteristics of 27 pediatric and young adult patients (2 months to 21 years) treated for symptomatic COVID-19 at a children's hospital in the Bronx, New York, between March 1 and May 31, 2020. D-Dimer was > 0.5 μg/mL (upper limit of normal) in 25 (93%) patients at admission; 11 (41%) developed peak D-dimer > 5 μg/mL during admission. Seven (26%) patients developed venous thromboembolism: three with deep vein thrombosis and four with pulmonary embolism. Requirement of increased ventilatory support was a risk factor for thrombosis (P = 0.006). Three of eight (38%) patients on prophylactic anticoagulation developed thrombosis; however, no patients developed VTE on low-molecular-weight heparin prophylaxis titrated to anti-Xa level. Manifestation of COVID-19 disease was severe or critical in 16 (59%) patients. Four (15%) patients died of COVID-19 complications: all had comorbidities. Elevated D-dimer and increased VTE rate were observed in this young cohort, particularly in those with severe respiratory complications, suggesting thrombotic coagulopathy. More data are needed to guide thromboprophylaxis in this age group.

Original languageEnglish (US)
Article numbere28975
JournalPediatric Blood and Cancer
Issue number7
StatePublished - Jul 2021


  • COVID-19
  • SARS-Co-V2
  • pediatric
  • thrombosis
  • venous thromboembolism
  • young adult

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology


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