Abstract 16904: Hypercoagulability in Pediatric Patients Infected With SARS-Coronavirus 2

Abstract

Introduction: Thrombosis is a complication associated with Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), Corona Virus Disease 2019 (COVID-19). Although, abnormalities in coagulation markers have been reported in adults with COVID-19, coagulopathy in pediatric patients infected with coronavirus has not been elucidated. Hypothesis: In this study, we evaluated the coagulation profile in pediatric patients with COVID-19 using Thromboelastography (TEG). Methods: This is a retrospective study of pediatric (≤18yrs) patients with seropositive COVID-19 (N=35) regardless of symptom status. Coagulation markers including TEG were obtained from review of medical records under an IRB approved study. All TEG parameters were compared between patients with COVID-19 and age matched controls without COVID-19 (N=35). Results: Regardless of symptom status, COVID-19 patients had significantly lower R-time (5.3±2.7 min vs. 6.5±1.5 min; p=0.03 ), K-time (1.1±0.3 min vs. 1.8±1.1 min; p<0.001 ) and fibrinolysis (1.7±1.7% vs. 3.2±3.6%; p=0.04 ); and significantly elevated angle (73.6±4.8 deg vs.66.7±6.2 deg; p<0.001 ), maximum amplitude (68.9±6.1 mm vs. 59.5±8.7 mm; p<0.001 ) and overall clot strength G (11.7±3.3 Kdynes/cm 2 vs. 7.8±2.4 Kdynes/cm 2 ; p<0.001 ). Whereas the standard coagulation tests such as PT/INR, PTT, Thrombin time and Heparin levels were within the normal pediatric reference ranges. D-dimer expression was also higher (0.94 μg/ml) in COVID-19 patients compared to the normal pediatric reference range (<0.4 μg/ml). In patients with COVID-19 undergoing aspirin therapy, all patients responded to the treatment and platelet function was significantly inhibited compared to patients not given aspirin (85% vs. 8% platelet inhibition; p<0.001 ). Conclusions: Abnormal expression of all TEG parameters and D-dimer is consistent with a hypercoagulable profile. TEG may be useful in reducing thrombosis-risk in patients with COVID-19 by guiding anticoagulation management.