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

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 th...

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Autores principales: Al‐Ghafry, Maha, Vagrecha, Anshul, Malik, Marium, Levine, Chana, Uster, Eliza, Aygun, Banu, Appiah‐Kubi, Abena, Vlachos, Adrianna, Capone, Christine A., Rajan, Sujatha, Palumbo, Nancy, Misra, Nilanjana, Mitchell, Elizabeth C., Wolfe, Lawrence C., Lipton, Jeffrey M., Shore‐Lesserson, Linda, Acharya, Suchitra S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9906141/
https://www.ncbi.nlm.nih.gov/pubmed/33872443
http://dx.doi.org/10.1111/jth.15340
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author Al‐Ghafry, Maha
Vagrecha, Anshul
Malik, Marium
Levine, Chana
Uster, Eliza
Aygun, Banu
Appiah‐Kubi, Abena
Vlachos, Adrianna
Capone, Christine A.
Rajan, Sujatha
Palumbo, Nancy
Misra, Nilanjana
Mitchell, Elizabeth C.
Wolfe, Lawrence C.
Lipton, Jeffrey M.
Shore‐Lesserson, Linda
Acharya, Suchitra S.
author_facet Al‐Ghafry, Maha
Vagrecha, Anshul
Malik, Marium
Levine, Chana
Uster, Eliza
Aygun, Banu
Appiah‐Kubi, Abena
Vlachos, Adrianna
Capone, Christine A.
Rajan, Sujatha
Palumbo, Nancy
Misra, Nilanjana
Mitchell, Elizabeth C.
Wolfe, Lawrence C.
Lipton, Jeffrey M.
Shore‐Lesserson, Linda
Acharya, Suchitra S.
author_sort Al‐Ghafry, Maha
collection PubMed
description 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.
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spelling pubmed-99061412023-02-08 Multisystem inflammatory syndrome in children (MIS‐C) and the prothrombotic state: Coagulation profiles and rotational thromboelastometry in a MIS‐C cohort Al‐Ghafry, Maha Vagrecha, Anshul Malik, Marium Levine, Chana Uster, Eliza Aygun, Banu Appiah‐Kubi, Abena Vlachos, Adrianna Capone, Christine A. Rajan, Sujatha Palumbo, Nancy Misra, Nilanjana Mitchell, Elizabeth C. Wolfe, Lawrence C. Lipton, Jeffrey M. Shore‐Lesserson, Linda Acharya, Suchitra S. J Thromb Haemost Brief Report 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. International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. 2021-07 2022-12-21 /pmc/articles/PMC9906141/ /pubmed/33872443 http://dx.doi.org/10.1111/jth.15340 Text en Copyright © 2021 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Brief Report
Al‐Ghafry, Maha
Vagrecha, Anshul
Malik, Marium
Levine, Chana
Uster, Eliza
Aygun, Banu
Appiah‐Kubi, Abena
Vlachos, Adrianna
Capone, Christine A.
Rajan, Sujatha
Palumbo, Nancy
Misra, Nilanjana
Mitchell, Elizabeth C.
Wolfe, Lawrence C.
Lipton, Jeffrey M.
Shore‐Lesserson, Linda
Acharya, Suchitra S.
Multisystem inflammatory syndrome in children (MIS‐C) and the prothrombotic state: Coagulation profiles and rotational thromboelastometry in a MIS‐C cohort
title Multisystem inflammatory syndrome in children (MIS‐C) and the prothrombotic state: Coagulation profiles and rotational thromboelastometry in a MIS‐C cohort
title_full Multisystem inflammatory syndrome in children (MIS‐C) and the prothrombotic state: Coagulation profiles and rotational thromboelastometry in a MIS‐C cohort
title_fullStr Multisystem inflammatory syndrome in children (MIS‐C) and the prothrombotic state: Coagulation profiles and rotational thromboelastometry in a MIS‐C cohort
title_full_unstemmed Multisystem inflammatory syndrome in children (MIS‐C) and the prothrombotic state: Coagulation profiles and rotational thromboelastometry in a MIS‐C cohort
title_short Multisystem inflammatory syndrome in children (MIS‐C) and the prothrombotic state: Coagulation profiles and rotational thromboelastometry in a MIS‐C cohort
title_sort multisystem inflammatory syndrome in children (mis‐c) and the prothrombotic state: coagulation profiles and rotational thromboelastometry in a mis‐c cohort
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9906141/
https://www.ncbi.nlm.nih.gov/pubmed/33872443
http://dx.doi.org/10.1111/jth.15340
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