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Coagulation Profiles and Viscoelastic Testing in Multisystem Inflammatory Syndrome
  • +11
  • Ashish Ankola,
  • Victoria Bradford,
  • Jane Newburger,
  • Sirisha Emani,
  • Audrey Dionne,
  • Kevin Friedman,
  • Mary Beth Son,
  • Lauren Henderson,
  • Pui Lee,
  • Amy Hellinger,
  • Beth Hawkins,
  • Courtney Ventresco,
  • Paul Esteso,
  • Christina VanderPluym
Ashish Ankola
Boston Children's Hospital
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Victoria Bradford
Boston Children's Hospital
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Jane Newburger
Boston Children's Hospital
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Sirisha Emani
Boston Children's Hospital
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Audrey Dionne
Boston Children's Hospital
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Kevin Friedman
Boston Children's Hospital
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Mary Beth Son
Boston Children's Hospital
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Lauren Henderson
Boston Children's Hospital
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Pui Lee
Boston Children's Hospital
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Amy Hellinger
Boston Children's Hospital
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Beth Hawkins
Boston Children's Hospital
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Courtney Ventresco
Boston Children's Hospital
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Paul Esteso
Boston Children's Hospital
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Christina VanderPluym
Boston Children's Hospital
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Abstract

Objective: To characterize viscoelastic testing profiles of children with multisystem inflammatory syndrome in children (MIS-C). Methods: This single-center retrospective review included 30 patients diagnosed with MIS-C from January 1 to September 1, 2020. Thromboelastography (TEG) with platelet mapping was performed in 19 (63%) patients and compared to age- and gender- matched controls via Student’s t-test and Wilcoxon rank sum test. Pearson’s and Spearman correlation were used to assess relationships between TEG parameters and inflammatory markers. Results: Patients with MIS-C had abnormal TEG results compared to controls, including decreased K time (1.1 vs. 1.7 min, P<0.01), increased alpha angle (75.0 vs. 65.7 degrees, P<0.01), increased maximum amplitude (70.8 vs. 58.3 mm, P<0.01), and decreased Ly-30 (1.1 vs. 3.7%, P=0.03); consistent with increased clot formation rate and strength, and slower fibrinolysis. TEG maximum amplitude was moderately correlated with erythrocyte sedimentation rate (r=0.60, P=0.02), initial platelet count (r=0.67, P<0.01), and peak platelet count (r=0.51, P=0.03). TEG alpha angle was moderately correlated with peak platelet count (r=0.54, P=0.02). 17 (57%) patients received aspirin (ASA) and anticoagulation, 5 (17%) received only ASA, and 3 (10%) received only anticoagulation. No patients had a thrombotic event. 6 (20%) patients had a bleeding event, none of which was major. Conclusions: Patients with MIS-C had evidence of hypercoagulability on TEG. Increased erythrocyte sedimentation rate and platelets were associated with higher clot strength. Treatment with ASA or anticoagulation was well tolerated. Further multi-center study is required to characterize the rate of thrombosis and optimal thromboprophylaxis algorithm in this patient population.

Peer review status:IN REVISION

04 May 2021Assigned to Editor
04 May 2021Submission Checks Completed
04 May 2021Submitted to Pediatric Blood & Cancer
08 May 2021Reviewer(s) Assigned
23 May 2021Review(s) Completed, Editorial Evaluation Pending
27 May 2021Editorial Decision: Revise Major