Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA.
Division of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA.
J Thromb Haemost. 2021 Jul;19(7):1764-1770. doi: 10.1111/jth.15340. Epub 2021 Jun 4.
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.
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.
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).
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.
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.
感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的成年人血栓形成率很高。一种在感染 SARS-CoV-2 的儿童中出现的新病症，即儿童多系统炎症综合征（MIS-C），其血栓形成状态或需要进行血栓预防的数据有限。
我们旨在通过凝血谱、旋转血栓弹性测定法（ROTEM）参数和临床结局来分析血栓形成状态，以确定这是否有助于进行血栓预防的风险分层。
该分析包括诊断为 MIS-C（n=40）的患者和对照组（因疑似 MIS-C 就诊但后来排除；n=26）的年龄<21 岁的患者。
与对照组相比，MIS-C 患者的炎症标志物水平更高，包括 D-二聚体（p<0.0001），并且 ROTEM 显示存在高凝状态，纤维蛋白原活性（FIBTEM）最大凝块硬度（MCF）升高（p<0.05）。对于 D-二聚体>1000ng/ml 的 MIS-C 患者，FIBTEM MCF 与平均 37.4（标准差 5.1）之间存在显著相关性（p<0.0001）。D-二聚体>2144ng/ml 可预测入住重症监护病房（AUC 0.80；95%置信区间，0.60-0.99；p<0.01；敏感性：82%，特异性：75%），以及 FIBTEM MCF 升高（>2500ng/ml 时 AUC 为 1）。50%的 MIS-C 患者（除了阿司匹林之外，还接受了依诺肝素预防血栓），在门诊随访时其炎症和 ROTEM 参数显著改善；无患者出现有症状的血栓形成。
尽管观察到血栓形成状态，但接受阿司匹林治疗或联合依诺肝素治疗的 MIS-C 患者均未出现有症状的血栓形成。除了凝血谱之外，ROTEM 可能有助于为重症 MIS-C 患者量身定制血栓预防方案。
