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.