Coagulation profiles and viscoelastic testing in multisystem inflammatory syndrome in children
Coagulation profiles and viscoelastic testing in multisystem inflammatory syndrome in children
复制标题
DOI：
10.1002/pbc.29355
复制
发表时间：
2021-09-17
影响因子：
3.2
通讯作者：
VanderPluym, Christina J.
中科院分区：
文献类型：
--
作者：
Ankola, Ashish A.;Bradford, Victoria R.;VanderPluym, Christina J.
目的探讨儿童多系统炎症综合征(MIS-C)的粘弹性测试特征。方法对2020年3月1日至9月1日收治的30例患者进行单中心回顾性研究。19名患者(63%)在心脏手术前接受了血栓弹性成像(TEG)和血小板测绘，并与年龄和性别匹配的对照组进行了比较。TEG参数与炎症标志物之间的关系通过相关性进行评估。结果与对照组相比，MI-C患者的TEG结果异常，包括运动时间(K)缩短(1.1比1.7分钟，P<0.01)，α角增大(75.0度比65.7度，P<0.01)，最大波幅增大(70.8比58.3 mm，P<0.01)，30min溶血率降低(1.1%比3.7%，P=0.03)，与血栓形成率和强度增加一致，纤溶活性降低。TEG最大波幅与血沉(ESR)(r=0.60，p=0.02)、初始血小板计数(r=0.67，p<；0.01)和峰值血小板计数(r=0.51，p=0.03)呈中度相关。TAGα角与血小板峰值计数呈中度相关(r=0.54，p=0.02)。17名患者(57%)接受阿司匹林(ASA)和抗凝治疗，5名(17%)仅接受ASA治疗，3名(10%)仅接受抗凝治疗。没有患者出现症状性血栓事件。6名患者(20%)有出血事件，没有一例是重大的。结论MIS-C患者TEG表现为高凝状态。血沉和血小板的增加与较高的凝血强度相关。患者接受了ASA或抗凝的预防性治疗，没有出现症状性血栓形成或大出血。需要进一步的多中心研究来确定该患者群体的血栓形成率和最佳血栓预防算法。
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 March 1 to September 1, 2020. Thromboelastography (TEG) with platelet mapping was performed in 19 (63%) patients and compared to age- and sex-matched controls prior to cardiac surgery. Relationships between TEG parameters and inflammatory markers were assessed using correlation. Results Patients with MIS-C had abnormal TEG results compared to controls, including decreased kinetic (K) time (1.1 vs. 1.7 minutes, p < .01), increased alpha angle (75.0 degrees vs. 65.7 degrees, p < .01), increased maximum amplitude (70.8 vs. 58.3 mm, p < .01), and decreased lysis in 30 minutes (Ly30) (1.1% vs. 3.7%, p = .03); consistent with increased clot formation rate and strength, and reduced fibrinolysis. TEG maximum amplitude was moderately correlated with erythrocyte sedimentation rate (ESR) (r = 0.60, p = .02), initial platelet count (r = 0.67, p < .01), and peak platelet count (r = 0.51, p = .03). TEG alpha angle was moderately correlated with peak platelet count (r = 0.54, p = .02). Seventeen (57%) patients received aspirin (ASA) and anticoagulation, five (17%) received only ASA, and three (10%) received only anticoagulation. No patients had a symptomatic thrombotic event. Six (20%) patients had a bleeding event, none of which was major. Conclusions Patients with MIS-C had evidence of hypercoagulability on TEG. Increased ESR and platelets were associated with higher clot strength. Patients were prophylactically treated with ASA or anticoagulation with no symptomatic thrombosis or major bleeding. Further multicenter study is required to characterize the rate of thrombosis and optimal thromboprophylaxis algorithm in this patient population.