Discussion
Most revealing from this study, we observed increased evidence of clot strength in ROTEM parameters of EXTEM MCF and FIBTEM MCF (suggestive of increased clot firmness by contribution from fibrinogen), similar to that reported by Rannucci et al6. We also noted that in the early stages of SARS-CoV-2 infection, children under age 21 had elevated fibrinogen, D-dimer levels, and CRP (all suggestive of a highly inflammatory state), in addition to lymphopenia and prolonged PT (similar to those observed in adults). However, our pediatric cohort did not develop symptomatic thromboembolic events or increased mortality, despite demonstration of a comparable hypercoagulable state.
Although our patient population was heterogeneous with respect to clinical course and level of coagulopathy, our small sample size precludes a demonstrable correlation between fibrinogen, D-dimers or viscoelastic testing or its predictive value in assigning risk for thrombosis on prophylactic anticoagulation in children. However, we demonstrated that ROTEM testing is feasible and recommend that it’s utility in determining the hypercoagulable state merits further study in children, who we and others, have shown can exhibit clinical severity and laboratory evidence of a coagulopathy identical to that seen in adults with SARS-CoV-2.