Comparison of thrombolytic therapy for prosthetic valve thrombosis at the mitral and aortic position

Singh, Aditya Kumar; Agarwal, Saket; Satyarthi, Subodh; Kunal, .; Satsangi, Deepak Kumar

doi:10.1007/s12055-011-0110-8

Cited by 3 publications

(2 citation statements)

References 17 publications

(17 reference statements)

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“…In a retrospective study by Singh AK et al, thrombolytic therapy for the thrombosed prosthetic bileaflet mechanical valve at the mitral and the aortic position was compared [219]. Overall, 53% and 27% patients had complete and partial resolution with thrombolytic therapy and in 20% patients, no change was observed.…”

Section: Thrombosis Of Prosthetic Valvesmentioning

confidence: 99%

Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario

Saksena

Mishra

Muralidharan

et al. 2019

Indian J Thorac Cardiovasc Surg

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Purpose Valvular heart disease (VHD) patients after prosthetic valve implantation are at risk of thromboembolic events. Followup care of patients with prosthetic valve has a paramount role in reducing the morbidity and mortality. Currently, in India, there is quintessential need to stream line the follow-up care of prosthetic valve patients. This mandates the development of a consensus guideline for the antithrombotic therapy in VHD patients post prosthetic valve implantation. Methods A national level panel was constituted comprising 13 leading cardio care experts in India who thoroughly reviewed the up to date literature, formulated the recommendations, and developed the consensus document. Later on, extensive discussions were held on this draft and the recommendations in 8 regional meetings involving 79 additional experts from the cardio care in India, to arrive at a consensus. The final consensus document is developed relying on the available evidence and/or majority consensus from all the meetings. Results The panel recommended vitamin K antagonist (VKA) therapy with individualized target international normalized ratio (INR) in VHD patients after prosthetic valve implantation. The panel opined that management of prosthetic valve complications should be personalized on the basis of type of complications. In addition, the panel recommends to distinguish individuals with various co-morbidities and attend them appropriately. Conclusions Anticoagulant therapy with VKA seems to be an effective option post prosthetic valve implantation in VHD patients. However, the role for non-VKA oral therapy in prosthetic valve patients and the safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valve need to be studied extensively.

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Section: Thrombosis Of Prosthetic Valvesmentioning

confidence: 99%

Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario

Saksena

Mishra

Muralidharan

et al. 2019

Indian J Thorac Cardiovasc Surg

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“…Full success with normalization of gradients was noted in over half the cases, and partial success in a quarter; 8% died. [18] Tenecteplase too has been used for prosthetic valve thrombosis. [19] Thus, our case, adds another question to the enigma of prosthetic valve thrombosis we are still to learn why some patients do not develop a thrombus even when not on oral anticoagulants for long periods.…”

mentioning

confidence: 99%

Mitral Mechanical Prosthetic Valve Thrombosis Four Years After Discontinuing Anticoagulation: A Case Report

Chitrapu¹,

Rao²,

D³

et al. 2015

jemds

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A 40 years lady who underwent a mitral valve replacement with a mechancial prosthesis nine years ago, stopped oral anticoagulants totally. She was asymptomatic and doing her field job with good exercise tolerance for 4 years without any anticoagulation or follow-up and presented now with acute pulmonary edema due to prosthetic valve thrombosis. Echocardiography revealed a large clot on the mitral valve and increased Doppler gradients across the valve. She was given intravenous streptokinase for 28 hours with relief of symptoms, re-appearance of prosthetic valve click and normalisation of flow velocities. She was prescribed oral acenocoumarol and discharged in a stable condition. CASE:Mrs. N, a 40 years lady was admitted with a two day history of Class IV dyspnea and was diagnosed to have mitral prosthetic valve thrombosis. She had undergone mitral valve replacement with a 27mm Medtronic Hall prosthesis for severe rheumatic mitral regurgitation in 2005; a permanent pacemaker was implanted when she developed complete heart block postoperatively. She was put on acenocoumarol and was on follow-up until 2011with an INR between 2 and 2.5. She discontinued oral anticoagulants and all drugs from August 2011 but reported no complaints -she had fair exercise tolerance and worked as a health worker which entailed field visits. She noticed mild dyspnea, but continued her work for the past 3 weeks, and was admitted now with acute pulmonary edema. The prosthetic valve click was muffled and the ECG showed a paced rhythm. Echocardiogram revealed decreased mobility of the mitral prosthesis with a large clot attached to it. The mitral flow gradients were very much increased with a peak gradient of 60 mm.Hg. And a mean gradient of 40 mm. Hg. She also had moderate aortic regurgitation and pulmonary hypertension with tricuspid regurgitation. The ejection fraction was 61.A diagnosis of prosthetic valve thrombosis was made and she was given intravenous streptokinase -2.5 lakh units as an intravenous bolus followed by an infusion of 1 lakh units per hour (for 28 hours). She was administered IV frusemide and sedation on admission in the ICCU. Acenocoumarol was also started at a dose of 2mg daily. By next day morning, she was better, the mitral valve click was well heard and echocardiography revealed a well-functioning mitral prosthesis with acceptable flow gradient -a peak of 8 and a mean of 3. Thrombus was not visible. She was administered enoxaparin 0.6mg bid for 5 days for the oral anticoagulant to take effect. The patient was discharged, in an asymptomatic condiction, and with fair effort tolerance, after 9 days, on acenocoumarol 2mg. daily and aspirin 75 mg.

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Treatment strategies for prosthetic valve thrombosis in pregnant patients

Joshi

2015

The American Journal of Emergency Medicine

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Comparison of thrombolytic therapy for prosthetic valve thrombosis at the mitral and aortic position

Cited by 3 publications

References 17 publications

Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario

Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario

Mitral Mechanical Prosthetic Valve Thrombosis Four Years After Discontinuing Anticoagulation: A Case Report

Treatment strategies for prosthetic valve thrombosis in pregnant patients

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