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Thrombotic events in critically ill children with myocarditis

Published online by Cambridge University Press:  09 September 2013

Kimberly Y. Lin ,
Basavaraj Kerur ,
Char M. Witmer ,
Lauren A. Beslow ,
Daniel J. Licht ,
Rebecca N. Ichord  and
Beth D. Kaufman
Kimberly Y. Lin*
Affiliation:
Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University Pennsylvania, Philadelphia, Pennsylvania, United States of America
Basavaraj Kerur
Affiliation:
Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
Char M. Witmer
Affiliation:
Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University Pennsylvania, Philadelphia, Pennsylvania, United States of America
Lauren A. Beslow
Affiliation:
Departments of Pediatrics and Neurology, Yale University School of Medicine, New Haven, Connecticut, United States of America
Daniel J. Licht
Affiliation:
Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University Pennsylvania, Philadelphia, Pennsylvania, United States of America
Rebecca N. Ichord
Affiliation:
Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University Pennsylvania, Philadelphia, Pennsylvania, United States of America
Beth D. Kaufman
Affiliation:
Division of Cardiology, Department of Pediatrics, Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, United States of America
*
Correspondence to: K. Y. Lin, MD, Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University Pennsylvania, 8th Floor Main Building, 34th and Civic Center Boulevard, Philadelphia, PA 19104, United States of America. Tel: 267-426-5700; Fax: 215-590-1340; E-mail: [email protected]
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Abstract

Background: Children with myocarditis have multiple risk factors for thrombotic events, yet the role of antithrombotic therapy is unclear in this population. We hypothesised that thrombotic events in critically ill children with myocarditis are common and that children with myocarditis are at higher risk for thrombotic events than children with non-inflammatory dilated cardiomyopathy. Methods: This is a retrospective chart review of all children presenting to a single centre cardiac intensive care unit with myocarditis from 1995 to 2008. A comparison group of children with dilated cardiomyopathy was also examined. Antithrombotic regimens were recorded. The primary outcome of thrombotic events included intracardiac clots and any thromboembolic events. Results: Out of 45 cases with myocarditis, 40% were biopsy-proven, 24% viral polymerase chain reaction-supported, and 36% diagnosed based on high clinical suspicion. There were two (4.4%) thrombotic events in the myocarditis group and three (6.7%) in the dilated cardiomyopathy group (p = 1.0). Neither the use of any antiplatelet or anticoagulation therapy, use of intravenous immune globulin, presence of any arrhythmia, nor need for mechanical circulatory support were predictive of thrombotic events in the myocarditis, dilated cardiomyopathy, or combined groups. Conclusions: Thrombotic events in critically ill children with myocarditis and dilated cardiomyopathy occurred in 6% of the combined cohort. There was no difference in thrombotic events between inflammatory and non-inflammatory cardiomyopathy groups, suggesting that the decision to use antithrombotic prophylaxis should be based on factors other than the underlying aetiology of a child's acute decompensated heart failure.

Keywords

Anticoagulationcardiomyopathymyocarditisstroke
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 5 , October 2014 , pp. 840 - 847
Copyright
Copyright © Cambridge University Press 2013 

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