Prosthetic valve thrombosis in a tertiary cardiac centre

Hirachan, Anish; Roka, Madhu; Prajapati, Dipanker; Adhikari, Chandra Mani; Bishal, K.C.; Khadka, Manjila Basnet; Maskey, Arun; Sharma, Deewakar

doi:10.3126/njh.v14i1.17188

“…Further, majority (68.75%) of the patients were in the NYHA class I and II, 87.5% patients had subtherapeutic anticoagulation (INR < 1.6 in 14 patients) and showed a significantly decreased transvalvular gradient (P < 0.05) after TT. Few studies have reported 69-75% rate of inadequate anticoagulation and 2 - 3 times more prevalence of mitral valve vs. aortic valve thrombosis [13, 14].…”

Section: Discussionmentioning

confidence: 99%

Short-Term Clinical Follow-Up After Thrombolytic Therapy in Patients With Prosthetic Valve Thrombosis: A Single-Center Experience

Pradhan

¹

,

Bhandari

²

,

Gupta

³

et al. 2019

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BackgroundThrombolytic therapy has evolved as an alternative to surgery for prosthetic valve thrombosis (PVT). Therefore, this retrospective, single-center study aimed to evaluate the clinical profile of PVT and the role of thrombolytic therapy in patients with PVT.MethodsData from a total of 16 consecutive patients with PVT enrolled between January 2017 and January 2018 at a tertiary care center in India were retrospectively evaluated. PVT was diagnosed based on clinical presentation, transthoracic echocardiography, and fluoroscopy. All patients received 0.25 MU intravenous (IV) bolus streptokinase over 30 min, followed by a 0.1 MU/h IV infusion for a maximum of 72 h. Transthoracic echocardiography and fluoroscopy were repeated after completion of thrombolysis session. The clinical endpoints were death and hemodynamic success within 24 h of thrombolytic therapy or during the hospital stay, and major complications, including stroke or major bleeding (intracranial bleed or bleeding requiring transfusion or surgical treatment) during the hospital stay and within 3 months of thrombolytic therapy.ResultsThe median age of the patients was 40 ± 11.60 years and about 62.5% (n = 10) were females. The median time between the valve placement and presentation for PVT was 3 years (range: 1 - 4 years). The peak gradient across the thrombotic mitral and aortic valve was 43.79 ± 18.47 and 93.5 ± 33.11 mmHg, respectively. At 3 days post-thrombolysis, peak gradient across both mitral valve (15.91 ± 7.56; mean gradient: 8.45 ± 4.01) and aortic valve (23.50 ± 6.45; mean gradient: 13.60 ± 3.83) decreased significantly (P ≤ 0.05). The thrombolytic therapy was successful in 13 (81.25%) patients. While, two (12.50%) patients died, none developed stroke or myocardial infarction during the study period.ConclusionsThe present study with short-term follow-up demonstrated the acceptable clinical efficacy of thrombolytic therapy. However, larger trials with a greater number of patients and longer follow-up are warranted to establish the safety and effectiveness of thrombolytic therapy in patients with PVT.

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“…In the series by Durrleman et al, they reported the maximum number of patients were in class III or IV at presentation (87%) [16]. Similarly in the study published by Gupta et al, reported that 46.4% of patients were in NYHA class III and 24.5 % of patients were in NYHA class IV at the time of presentation [18].…”

Section: Discussionmentioning

confidence: 93%

"Study Of Clinical Characteristics and Risk Determinants Of Patients With Prosthetic Valve Thrombosis: A Tertiary Care Hospital-Based Observational Study"

Asotra¹

2021

ACR

0

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Introduction: Prosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The present study aims to evaluate patients with prosthetic valve thrombosis in terms of the clinical characteristics, risk determinants, treatment, and outcomes in the prospective observational study. Material and Methods:The observational study was conducted in a tertiary care center. All patients suspected of having prosthetic valve dysfunction underwent clinical, echocardiography, and fluoroscopic examination. Data regarding risk determinants, clinical characteristics, and response to treatment was categorized on the basis of serial echocardiography and fluoroscopy into 3 classes; complete response, partial response, and failed treatment.Result: Out of 29 patients 17 (59%) were females and 12 (41%) were males. The mean age was 46.6years with an age range from 20-80 years. 15 (52%) patients were post MVR, 9 (32%), post DVR and 5 (17%) were post AVR. Dyspnoea was the presenting complaint in all the patients presenting with valve thrombosis. Mitral valve thrombosis was seen in 19 (65%), aortic valve thrombosis in 8 (28%), and tricuspid valve thrombosis in 2 (7%). 86% of patients had sub-therapeutic INR. Intensification of anticoagulation and thrombolytic therapy was the treatment modalities deployed.76% of patients received thrombolytic therapy and streptokinase was the most common agent used in 82% of patients. Majority of patients presented with symptoms of NYHA class III. 62% of patients showed complete response, 24% of patients showed partial response, and 4 (14%) had no response to lytic therapy. 7 out of 29 patients landed up in complications. 4 out of 29 patients had minor bleeds in the form of oral mucosal ooze and haematuria. 3 patients succumbed to complications, one of whom had a major bleed in the form of intracranial hemorrhage and two had worsening of heart failure. Conclusion:The most important risk factor attributed to the occurrence of prosthetic valve thrombosis was non-compliance to treatment leading to subtherapeutic INR. Mitral valve thrombosis was most commonly seen and Fibrinolysis can be considered as effective therapy even in patients presenting with NYHA Class III/IV especially in resource-stricken developing countries.

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“…The majority of studies have cited sub-therapeutic INR as a major risk factor for the development of PVT which was mainly due to irregular follow-up and poor treatment compliance. Studies from India show variable rates of inadequate anticoagulation ranging from 41.5 To 90.3% [18][19][20]. Egbe et al found inadequate anticoagulation in 48% of patients with PVT [21].…”

Section: Discussionmentioning

confidence: 99%

“…66.6%of our patients showed complete response to thrombolysis. 76.2% and77.5% of patients showed complete response to thrombolytic therpy in studies conducted by Nawale et al Kathirvel et al [18] [26].…”

mentioning

confidence: 96%

“…In a study conducted by Kathirvel et al 76.9 % of patients were thrombolysed with STK and 23.1 percent were thrombolysed with TNK [26]. In the study conducted by Hiracharan et al 86.9 % of patients were thrombolysed with STK and 13.1% were thrombolysed with TNK [18]. In our study, 62.1% of patients were thrombolysed with STK and 6.9 % were thrombolysed with TNK; 6.9 % were thrombolysed with alteplase and 24.1 % of patients were managed with the intensification of thrombolysis.…”

mentioning

confidence: 98%

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Untitled

2021

ACR

0

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Introduction: Prosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The present study aims to evaluate patients with prosthetic valve thrombosis in terms of the clinical characteristics, risk determinants, treatment, and outcomes in the prospective observational study. Material and Methods:The observational study was conducted in a tertiary care center. All patients suspected of having prosthetic valve dysfunction underwent clinical, echocardiography, and fluoroscopic examination. Data regarding risk determinants, clinical characteristics, and response to treatment was categorized on the basis of serial echocardiography and fluoroscopy into 3 classes; complete response, partial response, and failed treatment.Result: Out of 29 patients 17 (59%) were females and 12 (41%) were males. The mean age was 46.6years with an age range from 20-80 years. 15 (52%) patients were post MVR, 9 (32%), post DVR and 5 (17%) were post AVR. Dyspnoea was the presenting complaint in all the patients presenting with valve thrombosis. Mitral valve thrombosis was seen in 19 (65%), aortic valve thrombosis in 8 (28%), and tricuspid valve thrombosis in 2 (7%). 86% of patients had sub-therapeutic INR. Intensification of anticoagulation and thrombolytic therapy was the treatment modalities deployed.76% of patients received thrombolytic therapy and streptokinase was the most common agent used in 82% of patients. Majority of patients presented with symptoms of NYHA class III. 62% of patients showed complete response, 24% of patients showed partial response, and 4 (14%) had no response to lytic therapy. 7 out of 29 patients landed up in complications. 4 out of 29 patients had minor bleeds in the form of oral mucosal ooze and haematuria. 3 patients succumbed to complications, one of whom had a major bleed in the form of intracranial hemorrhage and two had worsening of heart failure. Conclusion:The most important risk factor attributed to the occurrence of prosthetic valve thrombosis was non-compliance to treatment leading to subtherapeutic INR. Mitral valve thrombosis was most commonly seen and Fibrinolysis can be considered as effective therapy even in patients presenting with NYHA Class III/IV especially in resource-stricken developing countries.

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Prosthetic valve thrombosis in a tertiary cardiac centre

Cited by 5 publications

References 7 publications

Short-Term Clinical Follow-Up After Thrombolytic Therapy in Patients With Prosthetic Valve Thrombosis: A Single-Center Experience

Short-Term Clinical Follow-Up After Thrombolytic Therapy in Patients With Prosthetic Valve Thrombosis: A Single-Center Experience

"Study Of Clinical Characteristics and Risk Determinants Of Patients With Prosthetic Valve Thrombosis: A Tertiary Care Hospital-Based Observational Study"

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