Cardiology in the Young

Original Articles

Thrombotic events in critically ill children with myocarditis

Kimberly Y. Lina1 c1, Basavaraj Kerura2, Char M. Witmera3, Lauren A. Beslowa4, Daniel J. Lichta5, Rebecca N. Ichorda5 and Beth D. Kaufmana6

a1 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

a2 Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States of America

a3 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

a4 Departments of Pediatrics and Neurology, Yale University School of Medicine, New Haven, Connecticut, United States of America

a5 Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University Pennsylvania, Philadelphia, Pennsylvania, United States of America

a6 Division of Cardiology, Department of Pediatrics, Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, United States of America

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.

(Received February 05 2013)

(Accepted July 09 2013)

(Online publication September 09 2013)

Keywords

  • Anticoagulation;
  • cardiomyopathy;
  • myocarditis;
  • stroke

Correspondence

c1 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