TY - JOUR
T1 - Multisystem inflammatory syndrome in children (MIS-C) and the prothrombotic state
T2 - Coagulation profiles and rotational thromboelastometry in a MIS-C cohort
AU - Al-Ghafry, Maha
AU - Vagrecha, Anshul
AU - Malik, Marium
AU - Levine, Chana
AU - Uster, Eliza
AU - Aygun, Banu
AU - Appiah-Kubi, Abena
AU - Vlachos, Adrianna
AU - Capone, Christine A.
AU - Rajan, Sujatha
AU - Palumbo, Nancy
AU - Misra, Nilanjana
AU - Mitchell, Elizabeth C.
AU - Wolfe, Lawrence C.
AU - Lipton, Jeffrey M.
AU - Shore-Lesserson, Linda
AU - Acharya, Suchitra S.
N1 - Publisher Copyright:
© 2021 International Society on Thrombosis and Haemostasis
PY - 2021/7
Y1 - 2021/7
N2 - Background: Adults infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have had high rates of thrombosis. A novel condition in children infected with SARS-CoV-2, multisystem inflammatory syndrome in children (MIS-C), has limited data on their prothrombotic state or need for thromboprophylaxis. Objectives: We aimed to analyze the prothrombotic state using coagulation profiles, rotational thromboelastometry (ROTEM) parameters and clinical outcomes, to determine if this could aid in risk stratification for thromboprophylaxis. Methods: This analysis included patients (<21 years of age) with a diagnosis of MIS-C (n = 40) and controls (presenting with suspicion of MIS-C but later ruled out; n = 26). Results: MIS-C patients had higher levels of inflammatory markers including D-dimer (p <.0001), compared with controls, along with evidence of hypercoagulability on ROTEM with elevated evaluation of fibrinogen activity (FIBTEM) maximum clot firmness (MCF) (p <.05). For MIS-C patients with D-dimers >1000 ng/ml, there was a significant correlation of FIBTEM MCF (p <.0001) with a mean value of 37.4 (standard deviation 5.1). D-dimer >2144 ng/ml was predictive of intensive care unit admission (area under the curve [AUC] 0.80; 95% confidence interval, 0.60–0.99; p <.01; sensitivity: 82%, specificity: 75%), and elevated FIBTEM MCF (AUC 1 for >2500 ng/ml). MIS-C patients (50%) received enoxaparin thromboprophylaxis (in addition to aspirin) with significant improvement in their inflammatory and ROTEM parameters upon outpatient follow-up; none developed symptomatic thrombosis. Conclusions: Despite an observed prothrombotic state, none of the MIS-C patients (on aspirin alone or in combination with enoxaparin) developed symptomatic thrombosis. ROTEM, in addition to coagulation profiles, may be helpful to tailor thromboprophylaxis in critically ill MIS-C patients.
AB - Background: Adults infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have had high rates of thrombosis. A novel condition in children infected with SARS-CoV-2, multisystem inflammatory syndrome in children (MIS-C), has limited data on their prothrombotic state or need for thromboprophylaxis. Objectives: We aimed to analyze the prothrombotic state using coagulation profiles, rotational thromboelastometry (ROTEM) parameters and clinical outcomes, to determine if this could aid in risk stratification for thromboprophylaxis. Methods: This analysis included patients (<21 years of age) with a diagnosis of MIS-C (n = 40) and controls (presenting with suspicion of MIS-C but later ruled out; n = 26). Results: MIS-C patients had higher levels of inflammatory markers including D-dimer (p <.0001), compared with controls, along with evidence of hypercoagulability on ROTEM with elevated evaluation of fibrinogen activity (FIBTEM) maximum clot firmness (MCF) (p <.05). For MIS-C patients with D-dimers >1000 ng/ml, there was a significant correlation of FIBTEM MCF (p <.0001) with a mean value of 37.4 (standard deviation 5.1). D-dimer >2144 ng/ml was predictive of intensive care unit admission (area under the curve [AUC] 0.80; 95% confidence interval, 0.60–0.99; p <.01; sensitivity: 82%, specificity: 75%), and elevated FIBTEM MCF (AUC 1 for >2500 ng/ml). MIS-C patients (50%) received enoxaparin thromboprophylaxis (in addition to aspirin) with significant improvement in their inflammatory and ROTEM parameters upon outpatient follow-up; none developed symptomatic thrombosis. Conclusions: Despite an observed prothrombotic state, none of the MIS-C patients (on aspirin alone or in combination with enoxaparin) developed symptomatic thrombosis. ROTEM, in addition to coagulation profiles, may be helpful to tailor thromboprophylaxis in critically ill MIS-C patients.
KW - COVID-19
KW - MIS-C
KW - pediatric
KW - ROTEM
KW - SARS-CoV-2
KW - thrombosis
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U2 - 10.1111/jth.15340
DO - 10.1111/jth.15340
M3 - Article
C2 - 33872443
AN - SCOPUS:85107154963
SN - 1538-7933
VL - 19
SP - 1764
EP - 1770
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 7
ER -