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Policy Adherence to Antithrombotic Therapy for Prophylactic Anticoagulation in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

Year: 2025

Type: article

Abstract: The primary objective of this study was to characterize prescribing compliance with antithrombic therapy at a quaternary academic medical center per institutional Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines. This single-center, retrospective study evaluated infants and children with MIS-C who received antithrombotic therapies for VTE prophylaxis between May 2020 and January 2022. Of the 62 patients admitted with MIS-C during the study period, 50 (81%) received enoxaparin prophylaxis and had at least one anti-Xa level drawn. 40 patients met our institutional guideline criteria for having an appropriately timed anti-Xa. The median weight-based dose of enoxaparin needed to attain a low molecular weight heparin (LMWH) anti-Xa between 0.2 to 0.5 IU/mL was 0.5 mg/kg (±0.09 mg/kg) every 12 hours. 39 (78%) patients achieved a goal LMWH anti-Xa with the initial guideline dosage. 40 patients (80%) received concomitant aspirin at a median dose of 3.1 mg/kg/day (IQR 1.6-25 mg/kg/day). Overall, 40 (80%) patients were started on enoxaparin per our center’s institutional guidelines. Our study demonstrated an empiric enoxaparin dose of 0.5 mg/kg (maximum initial dose 60 mg) every 12 hours resulted in zero VTE events. In conjunction with a median dose of 3.1 mg/kg/day of aspirin, these doses resulted in one bleeding event. • Optimal agents, dosing, and monitoring for VTE prevention in the setting of MIS-C have not been thoroughly established • Our study demonstrates enoxaparin dosing of 0.5 mg/kg twice daily for children greater than two years old appears effective in the prevention of VTE by achieving goal LMWH anti-Xa levels of 0.2-0.5 IU/mL in the majority of patients for which the testing was performed, and elicited low rate of bleeding events. • The patients initiated on 0.5 mg/kg twice daily enoxaparin did not require dosage decreases for LMWH anti-Xa levels greater than 0.5 IU/mL, suggesting less subject variability in dose and anti-Xa target obtainment than what has been described in previous, non-MIS-C literature [ 9 ].

Source: The Journal of Pediatrics Clinical Practice

DOI: 10.1016/j.jpedcp.2025.200179

Authors: Amanda A. Clouser, David Procaccini, Courtney E. Lawrence, Anna C. Sick-Samuels, Carlton K.K. Lee