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Thrombotic events in critically ill children with myocarditis

  • Kimberly Y. Lin (a1), Basavaraj Kerur (a2), Char M. Witmer (a3), Lauren A. Beslow (a4), Daniel J. Licht (a5), Rebecca N. Ichord (a5) and Beth D. Kaufman (a6)...

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.

Copyright

Corresponding author

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: linky@email.chop.edu

References

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1. Gunthard, J, Stocker, F, Bolz, D, et al. Dilated cardiomyopathy and thrombo-embolism. Eur J Pediatr 1997; 156: 36.
2. Choi, SH, Jeong, SI, Yang, JH, et al. A single-center experience with intracardiac thrombosis in children with dilated cardiomyopathy. Pediatr Cardiol 2010; 31: 264269.
3. Kuhn, B, Shapiro, ED, Walls, TA, Friedman, AH. Predictors of outcome of myocarditis. Pediatr Cardiol 2004; 25: 379384.
4. Ramanan, AS, Pandit, N, Yashwant, M, Srinivas, A. Embolic stroke in myocarditis. Indian Pediatr 1993; 30: 531533.
5. Antoniak, S, Boltzen, U, Riad, A, et al. Viral myocarditis and coagulopathy: increased tissue factor expression and plasma thrombogenicity. J Mol Cell Cardiol 2008; 45: 118126.
6. Loh, E, Sutton, MS, Wun, CC, et al. Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med 1997; 336: 251257.
7. Thompson, PL, Robinson, JS. Stroke after acute myocardial infarction: relation to infarct size. Br Med J 1978; 2: 457459.
8. Grenier, MA, Osganian, SK, Cox, GF, et al. Design and implementation of the North American Pediatric Cardiomyopathy Registry. Am Heart J 2000; 139: S86S95.
9. Maron, BJ, Olivotto, I, Bellone, P, et al. Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 39: 301307.
10. Finsterer, J. Left ventricular non-compaction and its cardiac and neurologic implications. Heart Fail Rev 2010; 15: 589603.
11. Arslan, S, Sevimli, S, Gundogdu, F. Fatal biatrial thrombus in a patient with idiopathic restrictive cardiomyopathy during sinus rhythm. Int J Cardiol 2007; 117: e68e70.
12. Foerster, SR, Canter, CE, Cinar, A, et al. Ventricular remodeling and survival are more favorable for myocarditis than for idiopathic dilated cardiomyopathy in childhood: an outcomes study from the Pediatric Cardiomyopathy Registry. Circ Heart Fail 2010; 3: 689697.
13. Grogan, M, Redfield, MM, Bailey, KR, et al. Long-term outcome of patients with biopsy-proved myocarditis: comparison with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1995; 26: 8084.
14. Swain, SK, Dharmapuram, AK, Reddy, P, Ramdoss, N, Raghavan, SS, Kona, SM. Neonatal Blalock-Taussig shunt: technical aspects and postoperative management. Asian Cardiovasc Thorac Ann 2008; 16: 710.
15. Vaitkus, PT, Barnathan, ES. Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: a meta-analysis. J Am Coll Cardiol 1993; 22: 10041009.
16. Massie, BM, Collins, JF, Ammon, SE, et al. Randomized trial of warfarin, aspirin, and clopidogrel in patients with chronic heart failure: the Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial. Circulation 2009; 119: 16161624.
17. Homma, S, Thompson, JL, Pullicino, PM, et al. Warfarin and aspirin in patients with heart failure and sinus rhythm. N Engl J Med 2012; 366: 18591869.
18. Vandvik, PO, Lincoff, AM, Gore, JM, et al. Primary and secondary prevention of cardiovascular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e637Se668S.
19. Monagle, P, Chan, AK, Goldenberg, NA, et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e737Se801S.
20. Monagle, P, Cochrane, A, McCrindle, B, Benson, L, Williams, W, Andrew, M. Thromboembolic complications after fontan procedures – the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg 1998; 115: 493498.
21. Meune, C, Spaulding, C, Mahe, I, Lebon, P, Bergmann, JF. Risks versus benefits of NSAIDs including aspirin in myocarditis: a review of the evidence from animal studies. Drug Saf 2003; 26: 975981.
22. Tsukui, H, Abla, A, Teuteberg, JJ, et al. Cerebrovascular accidents in patients with a ventricular assist device. J Thorac Cardiovasc Surg 2007; 134: 114123.
23. Polito, A, Netto, R, Soldati, M, et al. Neurological complications during pulsatile ventricular assistance with the Berlin heart EXCOR in children: incidence and risk factors. Artif Organs 2013 [Epub ahead of print].
24. Lazar, RM, Shapiro, PA, Jaski, BE, et al. Neurological events during long-term mechanical circulatory support for heart failure: the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) experience. Circulation 2004; 109: 24232427.
25. Reinhartz, O, Keith, FM, El-Banayosy, A, et al. Multicenter experience with the thoratec ventricular assist device in children and adolescents. J Heart Lung Transplant 2001; 20: 439448.
26. Blume, ED, Naftel, DC, Bastardi, HJ, Duncan, BW, Kirklin, JK, Webber, SA. Outcomes of children bridged to heart transplantation with ventricular assist devices: a multi-institutional study. Circulation 2006; 113: 23132319.
27. Duncan, BW, Hraska, V, Jonas, RA, et al. Mechanical circulatory support in children with cardiac disease. J Thorac Cardiovasc Surg 1999; 117: 529542.

Keywords

Thrombotic events in critically ill children with myocarditis

  • Kimberly Y. Lin (a1), Basavaraj Kerur (a2), Char M. Witmer (a3), Lauren A. Beslow (a4), Daniel J. Licht (a5), Rebecca N. Ichord (a5) and Beth D. Kaufman (a6)...

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