title: Presentation, management and outcomes of thrombosis for children with cardiomyopathy.
abstract: BACKGROUND
  Thrombosis in children with dilated and inflammatory cardiomyopathy is an unpredictable complication with potentially important morbidity.
  
  
  OBJECTIVE
  To determine the prevalence, associated factors, management and outcomes of thrombosis in this setting.
  
  
  METHODS
  Data were obtained from review of medical records. Factors associated with thrombosis and the impact on outcome were sought.
  
  
  RESULTS
  From 1990 to 1998, 66 patients that presented with dilated cardiomyopathy were followed for a median interval of 1.4 years (range 0 to 9.79 years) from first presentation. Thrombosis was diagnosed in four patients at presentation and in four patients during follow-up. Thrombosis was noted in one additional patient at examination after death. The overall nine-year period prevalence of thrombosis was 14%. Anticoagulation was started at presentation in 31% of patients. The mean left ventricular ejection fraction at presentation was significantly lower in those given anticoagulation (19+/-8%) versus those who were not (32+/-15%; P < 0.001). The mean ejection fraction at presentation was similar in those patients with (25+/-10%) versus those without thrombosis (28+/-15%; P = 0.44). During follow-up, 11 patients died and seven underwent cardiac transplantation. Kaplan-Meier estimates of freedom from death or transplantation were 88% at three months, 81% at one year and 70% at five years. Survival free of transplantation was not affected by thrombosis.
  
  
  CONCLUSIONS
  Thrombosis is common in children with cardiomyopathy, can occur at any time in the patients' clinical course and is not related to clinical features or survival free of transplantation. The relevance and prevention of thrombosis in this setting remains unclear.
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada. brian.mccrindle@sickkids.ca
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Tara
authors.initials: T
authors.lastname: Karamlou
authors.forename: Harvey
authors.initials: H
authors.lastname: Wong
authors.forename: Nirupama
authors.initials: N
authors.lastname: Gangam
authors.forename: Kalyani R
authors.initials: KR
authors.lastname: Trivedi
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
authors.forename: Lee N
authors.initials: LN
authors.lastname: Benson
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D013927:Thrombosis / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants