Presentation, management and outcomes of thrombosis for children with cardiomyopathy.
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.
McCrindle
Brian W
BW
Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada. brian.mccrindle@sickkids.ca
Karamlou
Tara
T
Wong
Harvey
H
Gangam
Nirupama
N
Trivedi
Kalyani R
KR
Lee
Kyong-Jin
KJ
Benson
Lee N
LN
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
D000925:Anticoagulants