title: Thrombotic events in critically ill children with myocarditis.
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.
authors.affiliation: 1Division of Cardiology,Department of Pediatrics,Children's Hospital of Philadelphia, Perelman School of Medicine at theUniversity Pennsylvania,Philadelphia,Pennsylvania,United States of America.
authors.forename: Kimberly Y
authors.initials: KY
authors.lastname: Lin
authors.affiliation: 2Department of Pediatrics,Albert Einstein Medical Center,Philadelphia,Pennsylvania,United States of America.
authors.forename: Basavaraj
authors.initials: B
authors.lastname: Kerur
authors.affiliation: 3Division of Hematology,Department of Pediatrics,Children's Hospital of Philadelphia, Perelman School of Medicine at theUniversity Pennsylvania,Philadelphia,Pennsylvania,United States of America.
authors.forename: Char M
authors.initials: CM
authors.lastname: Witmer
authors.affiliation: 4Departments of Pediatrics and Neurology,Yale University School of Medicine,New Haven,Connecticut,United States of America.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
authors.affiliation: 5Departments of Neurology and Pediatrics,Children's Hospital of Philadelphia, Perelman School of Medicine at theUniversity Pennsylvania,Philadelphia,Pennsylvania,United States of America.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
authors.affiliation: 5Departments of Neurology and Pediatrics,Children's Hospital of Philadelphia, Perelman School of Medicine at theUniversity Pennsylvania,Philadelphia,Pennsylvania,United States of America.
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Ichord
authors.affiliation: 6Division of Cardiology,Department of Pediatrics,Lucille Packard Children's Hospital,Stanford University School of Medicine,Palo Alto,California,United States of America.
authors.forename: Beth D
authors.initials: BD
authors.lastname: Kaufman
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009205:Myocarditis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*; D014481:United States / Q000453:epidemiology
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