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Pediatric Blood and Cancer ; 69(SUPPL 2):S13, 2022.
Article in English | EMBASE | ID: covidwho-1885240


Background: Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) exhibit laboratory evidence of hypercoagulability and are at risk of experiencing thrombotic complications. We developed and implemented a standardized multidisciplinary treatment approach which encompassed a thromboprophylaxis protocol and a computerized clinical decision support system including a provider order set to guide and unify practice. In high-risk patients defined as critically ill and/or having additional risk factors for thromboembolism, prophylactic-dose enoxaparin (target anti-Factor Xa of 0.1-0.3 U/mL) was added. Objectives: To evaluate impact of implementation of a standardized thromboprophylaxis protocol in hospitalized patients with MIS-C. Design/Method: We conducted a retrospective study of patients who were admitted to our center between March 2020 and December 2021 with confirmed MIS-C based on Centers for Disease Control and Prevention case definition. Relevant data were extracted from prospectively maintained institutional databases and the electronic medical records and were summarized using descriptive statistics. Key outcome measures included frequency of objectively confirmed venous and/or arterial TE during hospitalization and within 30 days after discharge and frequency of major bleeding and/or clinically relevant nonmajor bleeding (CRNMB) defined according to the International Society on Thrombosis and Haemostasis criteria. Results: A total of 136 patients (59 females, median age 8 years) with confirmed MIS-C were included in this study. Forty-five patients (33%) were ≥12 years of age. Of 136 patients, 124 patients (91%) required intensive care unit (ICU) stay and 64 patients (47%) required a central venous catheter for a median duration of 5 days [Interquartile range (IQR) 4-7]. The median total hospital and ICU length of stays were 11 days [IQR 6-14] and 3 days [IQR 2-6], respectively. Prophylactic-dose enoxaparin was initiated in 119 patients (88%) who were deemed high-risk per our protocol at a median of 1 day after admission [IQR 0-3] achieving target levels at a median of 1 day [IQR 1-2]. The median first anti-Factor Xa level was 0.13 u/mL [IQR 0.05-0.19]. Only 1 patient (0.7%) developed symptomatic non-catheter related superficial vein thrombosis requiring therapeutic anticoagulation. There were no other TEs encountered in our cohort. Bleeding events occurred in 5 patients (4.2%). All bleeding events were considered CRNMB (gastrointestinal bleeding in 4 patients and epistaxis in 1 patient). There were no mortalities. Conclusion: Implementation of an institutional standardized thromboprophylaxis protocol in patients with MIS-C was feasible and led to timely initiation of prophylactic anticoagulation and low rates of TEs and bleeding complications.

Open Forum Infectious Diseases ; 7(SUPPL 1):S338, 2020.
Article in English | EMBASE | ID: covidwho-1185903


Background: Background: Multi-system Inflammatory Syndrome of Children (MIS-C) has recently emerged internationally as a serious inflammatory complication of SARS-CoV-2 infection with significant morbidity for the pediatric population. Methods: This observational retrospective cohort study includes 33 children meeting CDC criteria for MIS-C treated between March 15 and June 17, 2020 at Children's National Hospital in Washington DC. Clinical and demographic data were extracted from medical records and are summarized. Results: Of 33 hospitalized MIS-C patients, 42% were critically ill, and 58% were non-critically ill. The median age was 8.9 years (0.7-18.7 years). More males (58 %) than females (43 %) were represented in the MIS-C cohort. The majority (75%) of children had no underlying medical condition. Criteria for incomplete or complete Kawasaki Disease (KD) were present in 39% of patients, while an additional 9% had some features of KD. However the remaining 52% of MIS-C patients presented with other sub-phenotypes including prominent severe abdominal pain and/or nonspecific multiorgan dysfunction. 30% presented with shock requiring volume and/or inotropic support. SARS-CoV-2 antibodies were present in 61% of patients. Virus was detectable by PCR in 36% of patients. At the time of initial evaluation, 39% (13/33) of children had identified cardiac abnormalities including myocardial dysfunction (5/33;15%), coronary ectasia (4/33;12%), coronary aneurysm (3/33;9%), or pericardial effusion 5/33;15%) either alone or in combination. Cytokine profiling identified elevation of several cytokines in this cohort, including IL-6. Treatment has included intravenous immunoglobulin, aspirin, anakinra and other immunomodulatory therapies, with overall rapid response to therapy. No deaths have occurred. Conclusion: The emergence of MIS-C late in the surge of SARS-CoV-2 circulation in the Washington DC metropolitan region has added to the already significant burden of hospitalized and critically ill children in our region. A significant percentage of these children present with cardiac dysfunction and abnormalities, whether or not with KD features at presentation. Detailed characterization of immune responses and long term outcome of these patients is a priority.