Multisystem inflammatory syndrome in children (MIS-C) and the prothrombotic state: Coagulation profiles and rotational thromboelastometry in a MIS-C cohort

Maha Al-Ghafry, Anshul Vagrecha, Marium Malik, Chana Levine, Eliza Uster, Banu Aygun, Abena Appiah-Kubi, Adrianna Vlachos, Christine A. Capone, Sujatha Rajan, Nancy Palumbo, Nilanjana Misra, Elizabeth C. Mitchell, Lawrence C. Wolfe, Jeffrey M. Lipton, Linda Shore-Lesserson, Suchitra S. Acharya

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1764-1770
Number of pages7
JournalJournal of Thrombosis and Haemostasis
Volume19
Issue number7
DOIs
StatePublished - Jul 2021
Externally publishedYes

Keywords

  • COVID-19
  • MIS-C
  • pediatric
  • ROTEM
  • SARS-CoV-2
  • thrombosis

ASJC Scopus subject areas

  • Hematology

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