Methods
Data were recorded on patients younger than 21 years of age admitted to Cohen Children’s Medical Center between April 13th and April 29th, 2020, with varying illness severity associated with SARS-CoV-2 infection documented by a positive PCR-based test. Patients older than 21 years and those with known coagulopathy or undergoing anticoagulation for other conditions were excluded. In addition to clinical demographics, laboratory data including baseline coagulation and inflammatory markers along with results of ROTEM analysis (ROTEM delta, Instrumentation Laboratory – Werfen, Barcelona, Spain) were collected. Whole blood for ROTEM analyses was obtained within 1-4 days of admission and included EXTEM (for evaluation of the extrinsic pathway), INTEM (intrinsic pathway), FIBTEM (fibrinogen activity) and APTEM (fibrinolysis) as previously described11. The following ROTEM parameters were analyzed: (1) clotting time (CT) corresponding to the initiation phase of the clotting process; (2) clot formation time (CFT) reflects the measure of the propagation phase of whole blood clot formation; (3) maximum clot firmness (MCF) is the maximum amplitude in millimeters reached in the thromboelastogram.
Mean and ranges were calculated as appropriate for normalcy of data. Comparisons were performed with Spearman’s correlation and Mann Whitney testing using SPSS Statistics (Version 1.0.0.1347, Armonk, NY). The Northwell Health Institutional Review Board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent.