tetano
Editor, Senior Moderator
J Thromb Haemost
. 2021 Apr 19.
doi: 10.1111/jth.15340. Online ahead of print.
Multisystem Inflammatory Syndrome in Children (MIS-C) and the Prothrombotic State: Coagulation Profiles and Rotational Thromboelastometry in a MIS-C Cohort
Maha Al-Ghafry[SUP] 1 [/SUP], Anshul Vagrecha[SUP] 1 [/SUP], Marium Malik[SUP] 1 [/SUP], Chana Levine[SUP] 1 [/SUP], Eliza Uster[SUP] 2 [/SUP], Banu Aygun[SUP] 1 [/SUP], Abena Appiah-Kubi[SUP] 1 [/SUP], Adrianna Vlachos[SUP] 1 3 [/SUP], Christine A Capone[SUP] 3 4 5 [/SUP], Sujatha Rajan[SUP] 6 [/SUP], Nancy Palumbo[SUP] 7 [/SUP], Nilanjana Misra[SUP] 5 [/SUP], Elizabeth C Mitchell[SUP] 5 [/SUP], Lawrence C Wolfe[SUP] 1 [/SUP], Jeffrey M Lipton[SUP] 1 3 [/SUP], Linda Shore-Lesserson[SUP] 8 [/SUP], Suchitra S Acharya[SUP] 1 [/SUP]
Affiliations
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<0.0001), compared to controls, along with evidence of hypercoagulability on ROTEM with elevated FIBTEM MCF (p<0.05). For MIS-C patients with D-dimers >1000 ng/mL, there was a significant correlation of FIBTEM MCF (p<0.0001) 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% CI: 0.60-0.99; p<0.01; 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.
Keywords: COVID-19; MIS-C; Pediatric; ROTEM; SARS-CoV-2; Thrombosis.
. 2021 Apr 19.
doi: 10.1111/jth.15340. Online ahead of print.
Multisystem Inflammatory Syndrome in Children (MIS-C) and the Prothrombotic State: Coagulation Profiles and Rotational Thromboelastometry in a MIS-C Cohort
Maha Al-Ghafry[SUP] 1 [/SUP], Anshul Vagrecha[SUP] 1 [/SUP], Marium Malik[SUP] 1 [/SUP], Chana Levine[SUP] 1 [/SUP], Eliza Uster[SUP] 2 [/SUP], Banu Aygun[SUP] 1 [/SUP], Abena Appiah-Kubi[SUP] 1 [/SUP], Adrianna Vlachos[SUP] 1 3 [/SUP], Christine A Capone[SUP] 3 4 5 [/SUP], Sujatha Rajan[SUP] 6 [/SUP], Nancy Palumbo[SUP] 7 [/SUP], Nilanjana Misra[SUP] 5 [/SUP], Elizabeth C Mitchell[SUP] 5 [/SUP], Lawrence C Wolfe[SUP] 1 [/SUP], Jeffrey M Lipton[SUP] 1 3 [/SUP], Linda Shore-Lesserson[SUP] 8 [/SUP], Suchitra S Acharya[SUP] 1 [/SUP]
Affiliations
- PMID: 33872443
- DOI: 10.1111/jth.15340
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<0.0001), compared to controls, along with evidence of hypercoagulability on ROTEM with elevated FIBTEM MCF (p<0.05). For MIS-C patients with D-dimers >1000 ng/mL, there was a significant correlation of FIBTEM MCF (p<0.0001) 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% CI: 0.60-0.99; p<0.01; 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.
Keywords: COVID-19; MIS-C; Pediatric; ROTEM; SARS-CoV-2; Thrombosis.