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.