Abstract
Children with cardiomyopathy are at increased risk of thromboembolic events resulting from ventricular dysfunction, trabeculated myocardium and/or arrhythmias. Thromboprophylaxis is commonly prescribed despite limited data regarding indications and treatment strategy. We sought to evaluate the real-world practice variations in the management of outpatient thromboprophylaxis in children with cardiomyopathy through a survey of pediatric heart failure practitioners working at Advanced Cardiac Therapies Improving Outcomes Network (ACTION) centers.
Key findings:
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28 respondents (36% of ACTION centers) completed the survey, with varied experience levels.
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Less than half reported institutional thromboprophylaxis protocols.
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Common factors influencing initiation included history of thrombosis (96%), low LVEF (86%), type of cardiomyopathy (71%), and hearts.
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LVEF thresholds for starting therapy varied; 32% used <30%, 25% <25%.
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For DCM, 79% would start prophylaxis (61% with aspirin). Strategy often changed if LVEF improved.
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For LVNC, 93% would initiate prophylaxis; 21% would never stop it, even with improved function.
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For RCM, 46% would start prophylaxis, mainly aspirin.
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Years of experience didn’t significantly affect decisions, though newer practitioners leaned more toward aspirin alone.
This ACTION study was available online March 19, 2025 in Journal of Cardiac Failure. Congratulations to the authors:
- Madeleine Townsend, MD
- Matthew J. O’connor, MD
- Joseph A. Spinner, MD
- Shahnawaz Amdani, MD
- Jennifer Conway, MD
CITATION
Madeleine Townsend, et al. Practice Variation in Thromboprophylaxis Management of Outpatient Pediatric Cardiomyopathy Patients: Survey of ACTION Providers. Journal of Cardiac Failure. 2025. DOI: 10.1016/j.cardfail.2025.02.017
