Clinically Significant Thrombosis in Pediatric Heart Transplant Recipients During Their Waiting Period

• Published in: Pediatric cardiology Vol. 34; no. 2; pp. 334 - 340
• Main Authors: Law, Yuk M., Sharma, Sumeet, Feingold, Brian, Fuller, Bret, Devine, William A., Webber, Steven A.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-02-2013; Springer
• Subjects: Adolescent; Adult; Blood clot; Cardiac Surgery; Cardiology; Child; Child, Preschool; Children; Congenital heart disease; Diagnostic Imaging - methods; Female; Follow-Up Studies; Genetic disorders; Health aspects; Heart; Heart Diseases - diagnosis; Heart Diseases - epidemiology; Heart failure; Heart Failure - surgery; Heart Transplantation; Humans; Incidence; Infant; Infant, Newborn; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Organ transplant recipients; Original Article; Pediatrics; Preoperative Period; Retrospective Studies; Risk Assessment - methods; Risk Factors; Severity of Illness Index; Survival Rate; Thrombosis; Thrombosis - diagnosis; Thrombosis - epidemiology; Time Factors; Tissue and Organ Procurement; Transplantation; United States - epidemiology; Vascular Surgery; Waiting Lists; Young Adult; United States; Heart failure; Antithrombosis therapy; Congenital heart disease; Cardiomyopathy
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-012-0451-0

Thrombosis is a serious complication of heart failure for which available data on pediatric patients are scarce. This report describes the frequency and risk factors of clinically significant thrombosis (CST) for children awaiting transplantation. A retrospective study analyzed a cohort of heart recipients with CST, defined by the presence of intracardiac thrombus by imaging, explant pathology, or symptomatic clinical event. Among the 123 patients in the study, 56 % were male and 44 % had congenital heart disease. The median age at transplantation was 6.6 years (range 0–30 years). The prevalence of CST was 12.2 % (15/123), and its incidence was 32.7 events per 100 patient-years. The thromboembolic event frequencies were 2.4 % and 6.5 events per 100 patient-years. The median interval from listing to CST was eight days (range 0–113 days). The median wait-list duration was 31 days (range 8–169 days) in the CST group versus 51 days (range 0–1,743 days) in the non-CST group. Inpatient status was statistically associated with CST (14 of 15 subjects were inpatients,
p
 = 0.03). Inotropic support (
p
 = 0.068) and United Network for Organ Sharing (UNOS) status 1 (
p
 = 0.061) approached significance. Clinically significant thrombosis was common in this end-stage heart failure population. Until randomized clinical trial data are available, it may be reasonable to consider anticoagulation for children admitted with decompensated heart failure and listed as UNOS status 1.