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.