Dilated cardiomyopathy and thrombo-embolism

The purpose of this study was to investigate the incidence, outcome and prevention of thrombo-embolism in children with dilated cardiomyopathy. From 130 patients with dilated cardiomyopathy, 17 (14%) showed evidence of thrombo-embolism. Seven had initial cardiac thrombus, 7 exhibited initial embolus and in 3 thrombo-embolism was only diagnosed at autopsy. All 17 patients showed seriously impaired systolic function of the left ventricle with fractional shortening (FS) of 10 +/- 3%, range 5%-17%, as compared to those without thrombo-embolism with FS of 17% +/- 6%, range 5%-26% (P < 0.0001). Seven patients were treated with oral anticoagulants once thrombo-embolism had been diagnosed; one of them experienced a further embolic event as opposed to three out of four patients not treated with anticoagulants.

All children with dilated cardiomyopathy and fractional shortening below 20% should be treated with prophylactic anticoagulative agents.