The multisystem inflammatory syndrome in children (MIS-C) is a severe clinical entity affecting the coagulative system; although thromboembolic events (TEs) are not common, most patients receive anticoagulation. We retrospectively assessed patients below 18 years admitted with MIS-C at Meyer Children's Hospital (Florence, Italy). Data on baseline clinical and laboratory presentation, treatment, and outcome, including differences between patients with and without thrombotic prophylaxis, were analyzed. Thirty-two children 1 to 15 years were included. Seventeen patients (53.1%) required intensive care admission, 2 (8.7%) had obesity, 7 (30.4%) had a central venous catheter, and 14 (43.8%) impaired cardiac function. Twelve patients (37.5%) received prophylactic anticoagulation: they had more frequent cardiac involvement (91.7 vs. 50%, P=0.02) and higher ferritin levels (median 1240 vs. 501.5 ng/mL, P<0.001). No differences were found in median d-dimers between the 2 groups. Twenty-one patients (65.6%) had d-dimers >5×upper limit of normal but the indication for anticoagulation was not driven by d-dimers. No patient had hemorrhagic events and only 1 patient (3.1%) had a superficial thrombotic event (under thromboprophylaxis). Our series and the available literature data on MIS-C and thromboembolic events suggest that TEs are a rare complication of MIS-C that is frequently associated with high d-dimer values. However, also in MIS-C, the well-established risk factors of pediatric TEs (ie, older age, central venous catheter, obesity, and cancer) should guide thromboembolic risk assessment.

Anticoagulation and Thrombotic Events in the Multisystem Inflammatory Syndrome in Children: Experience of a Single-center Cohort and Review of the Literature / Pegoraro, Francesco; Lasagni, Donatella; Trapani, Sandra; Mastrolia, Maria V; Simonini, Gabriele; Indolfi, Giuseppe; Resti, Massimo. - In: JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY. - ISSN 1077-4114. - ELETTRONICO. - Publish Ahead of Print:(2022), pp. 0-0. [10.1097/MPH.0000000000002590]

Anticoagulation and Thrombotic Events in the Multisystem Inflammatory Syndrome in Children: Experience of a Single-center Cohort and Review of the Literature

Pegoraro, Francesco;Trapani, Sandra;Simonini, Gabriele;Indolfi, Giuseppe;Resti, Massimo
2022

Abstract

The multisystem inflammatory syndrome in children (MIS-C) is a severe clinical entity affecting the coagulative system; although thromboembolic events (TEs) are not common, most patients receive anticoagulation. We retrospectively assessed patients below 18 years admitted with MIS-C at Meyer Children's Hospital (Florence, Italy). Data on baseline clinical and laboratory presentation, treatment, and outcome, including differences between patients with and without thrombotic prophylaxis, were analyzed. Thirty-two children 1 to 15 years were included. Seventeen patients (53.1%) required intensive care admission, 2 (8.7%) had obesity, 7 (30.4%) had a central venous catheter, and 14 (43.8%) impaired cardiac function. Twelve patients (37.5%) received prophylactic anticoagulation: they had more frequent cardiac involvement (91.7 vs. 50%, P=0.02) and higher ferritin levels (median 1240 vs. 501.5 ng/mL, P<0.001). No differences were found in median d-dimers between the 2 groups. Twenty-one patients (65.6%) had d-dimers >5×upper limit of normal but the indication for anticoagulation was not driven by d-dimers. No patient had hemorrhagic events and only 1 patient (3.1%) had a superficial thrombotic event (under thromboprophylaxis). Our series and the available literature data on MIS-C and thromboembolic events suggest that TEs are a rare complication of MIS-C that is frequently associated with high d-dimer values. However, also in MIS-C, the well-established risk factors of pediatric TEs (ie, older age, central venous catheter, obesity, and cancer) should guide thromboembolic risk assessment.
2022
Publish Ahead of Print
0
0
Pegoraro, Francesco; Lasagni, Donatella; Trapani, Sandra; Mastrolia, Maria V; Simonini, Gabriele; Indolfi, Giuseppe; Resti, Massimo
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1297481
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