Thrombotic events in critically ill children with myocarditis
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Kimberly Y Lin1, Basavaraj Kerur2, Char M Witmer3
11Division of Cardiology,Department of Pediatrics,Children's Hospital of Philadelphia, Perelman School of Medicine at theUniversity Pennsylvania,Philadelphia,Pennsylvania,United States of America.
Insights
Thrombotic events occurred in 6% of critically ill children with myocarditis or dilated cardiomyopathy. The study found no difference in thrombotic events between inflammatory and non-inflammatory cardiomyopathy, suggesting prophylaxis decisions should not solely rely on etiology.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Hematology
Background:
- Children with myocarditis face risks for thrombotic events, but antithrombotic therapy use is not well-defined.
- This study investigated the incidence of thrombotic events in critically ill children with myocarditis and compared it to those with dilated cardiomyopathy.
Purpose of the Study:
- To determine the frequency of thrombotic events in critically ill children with myocarditis.
- To compare the risk of thrombotic events in children with myocarditis versus dilated cardiomyopathy.
- To identify factors associated with thrombotic events in these pediatric populations.
Main Methods:
- Retrospective chart review of children with myocarditis and dilated cardiomyopathy treated in a cardiac intensive care unit (1995-2008).
- Data collected included antithrombotic regimens, diagnoses, arrhythmias, and need for mechanical support.
- Primary outcome was the occurrence of thrombotic events, defined as intracardiac clots or thromboembolic events.
Main Results:
- Of 45 children with myocarditis, 4.4% experienced thrombotic events; 6.7% of children with dilated cardiomyopathy had events (p=1.0).
- No significant difference in thrombotic events was observed between the myocarditis and dilated cardiomyopathy groups.
- Neither antithrombotic therapy, intravenous immune globulin, arrhythmias, nor mechanical circulatory support predicted thrombotic events.
Conclusions:
- Thrombotic events occurred in approximately 6% of the combined cohort of critically ill children with myocarditis and dilated cardiomyopathy.
- The incidence of thrombotic events did not differ between inflammatory (myocarditis) and non-inflammatory (dilated cardiomyopathy) conditions.
- Etiology of acute decompensated heart failure should not be the sole factor in deciding on antithrombotic prophylaxis in children.
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.
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