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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.
04 May 2021Submitted to Pediatric Blood & Cancer
04 May 2021Submission Checks Completed
04 May 2021Assigned to Editor
08 May 2021Reviewer(s) Assigned
23 May 2021Review(s) Completed, Editorial Evaluation Pending
27 May 2021Editorial Decision: Revise Major
27 Jul 20211st Revision Received
27 Jul 2021Assigned to Editor
27 Jul 2021Submission Checks Completed
02 Aug 2021Reviewer(s) Assigned
22 Aug 2021Review(s) Completed, Editorial Evaluation Pending
26 Aug 2021Editorial Decision: Revise Minor
26 Aug 20212nd Revision Received
26 Aug 2021Submission Checks Completed
26 Aug 2021Assigned to Editor
29 Aug 2021Review(s) Completed, Editorial Evaluation Pending
30 Aug 2021Editorial Decision: Accept