Thrombotic events in critically ill children with myocarditis
Thrombotic events in critically ill children with myocarditis
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DOI：
10.1017/s1047951113001145
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发表时间：
2014-10-01
影响因子：
1
通讯作者：
Kaufman, Beth D.
中科院分区：
文献类型：
--
作者：
Lin, Kimberly Y.;Kerur, Basavaraj;Kaufman, Beth D.
背景资料：心肌炎患儿有多种血栓事件的危险因素，但抗血栓治疗在这一人群中的作用尚不清楚。我们假设，心肌炎重症患儿血栓形成事件很常见，心肌炎患儿发生血栓形成事件的风险高于非炎性扩张型心肌病患儿。研究方法：这是一个回顾性图表审查的所有儿童提出的一个单一的中心心脏重症监护病房心肌炎从1995年至2008年。还检查了扩张型心肌病儿童的对照组。记录抗血栓治疗方案。血栓形成事件的主要结局包括心内血栓和任何血栓栓塞事件。结果如下：在45例心肌炎病例中，40%经活检证实，24%病毒聚合酶链反应支持，36%基于高度临床怀疑诊断。心肌炎组有2例（4.4%）血栓事件，扩张型心肌病组有3例（6.7%）血栓事件（p=1.0）。在心肌炎、扩张型心肌病或合并组中，使用任何抗血小板或抗凝治疗、使用静脉注射免疫球蛋白、存在任何心律失常或需要机械循环支持均不能预测血栓形成事件。结论：合并心肌炎和扩张型心肌病的危重患儿血栓事件发生率为6%。炎症性和非炎症性心肌病组之间的血栓形成事件没有差异，这表明使用抗血栓预防的决定应基于儿童急性失代偿性心力衰竭的潜在病因以外的因素。
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.