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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...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Society on Thrombosis and Haemostasis. Published by Elsevier Inc.
2021
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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. |
format | Online Article Text |
id | pubmed-9906141 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
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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