Clinical profile and management of prosthetic valve thrombosis in Tertiary cardiac Centre of Nepal, a prospective study

Manandhar, Reeju; Prajapati, Dipanker; Tamrakar, Rikesh; Bogati, Amrit; Roka, Madhu; Sherpa, Kunjang; Shrestha, Shipra; Bhandari, Shreya; Chaudhary, Taanya; Yadav, Sunil Kumar; Adhikari, Chandra Mani

doi:10.3126/njh.v19i1.45276

Cited by 2 publications

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“…Prosthetic valve thrombosis is described as any blockage of the prosthesis caused by noninfectious thrombotic material or valverelated clotting that impairs valve performance [1]. Prosthetic valve blockage or trapped prosthesis refers to a variety of diseases, including pannus, thrombus, and vegetation [2].…”

Section: Introductionmentioning

confidence: 99%

Clinical Profile and Management of Prosthetic Valve Thrombosis in Tertiary Cardiac Centre

Tareen¹,

Saad²,

Bashir³

et al. 2022

PJMHS

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Background and Aim: Prosthetic valve thrombosis is a potentially fatal outcome of valve replacement surgery. A proportion of patients suffer with thrombotic problems, mostly as a result of inadequate anticoagulation status and irregular INR checks. The present study aimed to investigate the clinical profile and prosthetic valve thrombosis management in tertiary cardiac centers. Patients and Methods: This prospective study was carried out on 58 prosthetic valve thrombosis patients in AFIC, Rawalpindi and Punjab Institute of Cardiology, Lahore from January 2022 to June 2022. The study protocol was approved by the institutional research and ethical committee. All the enrolled patients provided informed written consent. Patients’ demographic details, clinical profile, in-hospital complications, and outcome during one year follow-up were recorded. SPSS version 28 was used for data analysis. Results: Of the total 58 PVT patients, there were 22 (37.9%) male and 36 (62.1%) females. The overall mean age was 32.84± 8.4 years with an age range 10-65 years. About 34 (58.6%) patients had sub-therapeutic INR values during admission time whereas 28 (48.3%) patients had atrial fibrillation. Breathing difficulties was the predominant complaint in 54 (92.8%) of the patients who came within one week after the beginning of symptoms. Approximately 51 patients (88.4%) had streptokinase thrombolysis, while four required surgery. Valve thrombosis was most prevalent in 49 (84.5%) of the individuals. In-hospital mortality was 9.8% (n=6), with no significant bleeding episodes or new strokes seen. Conclusion: The present study concluded that PV thrombosis is a medical emergency associated with a high mortality rate. Low socio-economic level leads to poor adherence to anticoagulation medication. The prosthetic valve thrombosis patients had poor compliance and sub-therapeutic INR. Prosthetic valve thrombosis can be effectively treated with thrombolysis. Keywords: Prosthetic valve thrombosis, Clinical profile, Thrombosis

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Section: Introductionmentioning

confidence: 99%

Clinical Profile and Management of Prosthetic Valve Thrombosis in Tertiary Cardiac Centre

Tareen¹,

Saad²,

Bashir³

et al. 2022

PJMHS

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Surgery Versus Thrombolytic Therapy for the Management of Left‐Sided Prosthetic Valve Thrombosis Without Hemodynamic Compromise: A Systematic Review and Meta‐Analysis

Chopard,

Vidoni,

Besutti

et al. 2024

JAHA

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Background The optimal strategy in prosthetic heart valve thrombosis (PVT) remains controversial, with no randomized trials and conflicting observational data. We performed a systematic review and meta‐analysis of evidence comparing systemic thrombolysis and cardiac surgery in PVT. Methods and Results We searched PubMed, the Cochrane Library, and Embase for studies on treatment strategies in patients with left‐sided PVT since 2000. The primary outcome was death, and the secondary outcomes were major bleeding and thromboembolism during follow‐up (International Prospective Register of Systematic Reviews No. CRD42022384092). We identified 2298 studies, of which 16 were included, comprising 1389 patients with PVT (mean age, 50.4±9.3 years; 60.0% women). Among them, 67.2% were New York Heart Association stage III/IV at admission. Overall, 48.1% were treated with systemic thrombolysis and 51.9% with cardiac surgery. The mortality rate was 10.8% in the thrombolysis group and 15.3% in the surgery group. The pooled risk difference for death with systemic thrombolysis was 1.13 (exact CI, 0.74–1.79; ζ 2 =0.89; P <0.001) versus cardiac surgery. Rates of both transient ischemic attack and non–central nervous system embolism were higher in the thrombolysis group ( P =0.002 and P =0.02, respectively). Treatment success, major bleeding, and stroke were similar between groups. Sensitivity analysis including studies that used low‐dose or slow‐infusion thrombolysis showed that the mortality rate was lower, and treatment success was higher, in patients referred to systemic thrombolysis, with similar rates of other secondary outcomes. Conclusions There is evidence to suggest that thrombolysis might be the preferred option for the management of PVT without cardiogenic shock, pending future randomized controlled trials or larger observational studies.

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Clinical profile and management of prosthetic valve thrombosis in Tertiary cardiac Centre of Nepal, a prospective study

Cited by 2 publications

References 0 publications

Clinical Profile and Management of Prosthetic Valve Thrombosis in Tertiary Cardiac Centre

Clinical Profile and Management of Prosthetic Valve Thrombosis in Tertiary Cardiac Centre

Surgery Versus Thrombolytic Therapy for the Management of Left‐Sided Prosthetic Valve Thrombosis Without Hemodynamic Compromise: A Systematic Review and Meta‐Analysis

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