Study of prosthetic heart valve thrombosis and outcomes after thrombolysis

Patil, Shivanand; Setty, Natraj; Ramalingam, Rangaraj; Rudrappa, Mahesh Murthy Bedar; Manjunath, Cholenahally Nanjappa

doi:10.18203/2320-6012.ijrms20191079

Cited by 7 publications

(6 citation statements)

References 12 publications

(14 reference statements)

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“…In our study, 82.86% of the patients either had suboptimal INR or poor compliance with oral warfarin therapy. Similar results were found in another study in which 55.50% of the patients had suboptimal INR and 20.90% of the patients were non-compliant with warfarin therapy [10]. The reason being female predominance of patients (58.50%) who are usually lost to follow-up after replacement resulting in suboptimal INR and poor compliance with warfarin.…”

Section: Discussionsupporting

confidence: 85%

Clinical Outcomes of Mechanical Prosthetic Valve Thrombosis

Khan

Ijaz

Ali

et al. 2020

Cureus

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To evaluate characteristics and outcomes of patients presenting with mechanical prosthetic valve thrombosis in a tertiary cardiac center in Pakistan. Methods This was a prospective and interventional study conducted at Rawalpindi Institute of Cardiology over a period of two years. The clinical characteristics of patients presenting with clinical suspicion of prosthetic valve thrombosis were recorded. They were, then, subjected to streptokinase, redo surgery and heparin based on their hemodynamic stability, thrombus burden and surgical risk. The patients were then followed for the outcomes of the study. Results Out of 576 patients with mechanical valve replacement during the study period, 70 patients had developed prosthetic valve thrombosis. Out of 70 patients, there were 41 female (58.50%) and 29 male (41.50%) participants. The mean age of the participants was 48.40±15.00 years. The overall incidence of mechanical prosthetic valve thrombosis was 12.15%. There were 30 patients (42.80%) with a suboptimal international normalized ratio (INR) and 28 patients (40.00%) were non-compliant to warfarin therapy. The overall incidence of adverse clinical outcome was 18.00%, while the overall mortality rate was 10.00%. The mortality was higher for patients who underwent redo surgery (16.60%) as compared to patients who had received fibrinolytic therapy (9.60%). Conclusion Poor compliance with warfarin and suboptimal INR are the important factors causing mechanical prosthetic valve. Because of lower mortality rate, fibrinolysis with streptokinase is a reasonable treatment option for mechanical prosthetic valve thrombosis.

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Section: Discussionsupporting

confidence: 85%

Clinical Outcomes of Mechanical Prosthetic Valve Thrombosis

Khan

Ijaz

Ali

et al. 2020

Cureus

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“…In this study, PVT was more common in women (51.8%) which is similar to the previous studies conducted in India showing that women have been more susceptible to PVT. 12 The results of this study support the findings of 13,14 Parallelly many studies have confirmed that occurrences of mitral PVT have been 2-3 times greater than with aortic PVT. 6,15 Besides, the majority of the patients in this study population have mechanical valve involvement than bioprosthetic valves and also higher number of patients had NYHA class II symptoms followed by III and IV symptoms which were similar to a study conducted by Patil S, et al 13 Streptokinase (87.5%) was the most commonly administered agent for thrombolysis followed by urokinase (10.7%) and tenecteplase (1.8%).…”

Section: Discussionsupporting

confidence: 83%

Efficacy and safety of thrombolytic therapy in prosthetic valve thrombosis

et al. 2020

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Background: There is limited data available about the effectiveness of thrombolysis in prosthetic valve thrombosis (PVT). Therefore, this study aimed to evaluate the efficacy and safety of thrombolytic treatment in PVT patients.Methods: This was an observational study conducted at a tertiary-care centre in India between March 2013 and April 2014. Total of 56 patients with either recurrent PVT or with confirmed left-sided PVT was included in the study. Thrombolytic therapy was administered as an intravenous infusion of streptokinase or urokinase, initially at a loading dose of 2.5L IU/hour over 30 minutes, followed by 1L IU/hour for 48–78 hours depending upon the clinical and 2D-Echo observation. Primary endpoint was considered as the occurrence of a complete clinical response. Secondary endpoint was considered as a composite of death, major bleeding or embolic stroke.Results: Mean age of the patients was 37±13 years. Most of the patients presented with NYHA-II (51.7%), III (39.2%), and IV (8.9%) symptoms. Mitral and aortic valve thrombosis were observed in 40(71.4%) and 11(28.6%) patients. Forty-nine (73.3%) patients were treated with streptokinase. Whereas, rethrombosis patients were treated with urokinase [6(16%)] and tenecteplase [1(1.3%)]. Two (3.6%) patients died, 1(1.8%), 1(1.8%), 2(3.6%), and 1(1.8%) patient had peripheral embolism, central nervous system bleeding, stroke, and embolic complications.Conclusions: Thrombolytic therapy can be used as the first-line treatment for thrombolysis in PVT patients. All PVT patients can be treated with streptokinase unless specific contraindications exist. Urokinase or tenecteplase is an alternative thrombolytic agent in rethrombosis patients.

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“…8 Patil et al and Gupta et al showed that mitral valve prosthesis was most commonly involved in the patients (71.5%) compared to aortic valve prosthesis (19.6%). 9,10 Diagnosis is often confirmed by fluoroscopy or echocardiography. Although TTE is used for calculation of gradient and response to thrombolytic therapy, definitive diagnosis is greatly aided by TEE, particularly three-dimensional echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Thrombolytic therapy as first line treatment in prosthetic mitral valve thrombosis

et al. 2023

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Background: A very common post-operative mechanical complication of a prosthetic valve is thrombosis leading to valve being stuck. This leads to rapid development of heart failure and can result in sudden death of the patient in an aggravated manner. The study aims to put forth the importance of immediate thrombolysis in such patients which can provide bridging between the event and immediate surgery. Methods: A total of 50 patients were retrospectively studied after presentation with prosthetic valve thrombosis and the thrombolytic agent used in all the cases was injectable streptokinase or urokinase. Post streptokinase patients were given heparin infusion and oral anticoagulants. The therapy was considered failure if transvalvular gradients decreased less than 50% or in case of persistent valve motion abnormality. Results: 94% patients had complete normalisation of valve function and decrease in transvalvular gradients to less than 50% within the first 24 hours. 4% patients required surgery and 2% patients could not survive the treatment. Conclusions: Immediate thrombolysis on presentation has shown significant improvement in survival without the risk of subjecting patients to redo surgeries which are associated with multiple complications in the perioperative period.

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Study of prosthetic heart valve thrombosis and outcomes after thrombolysis

Cited by 7 publications

References 12 publications

Clinical Outcomes of Mechanical Prosthetic Valve Thrombosis

Clinical Outcomes of Mechanical Prosthetic Valve Thrombosis

Efficacy and safety of thrombolytic therapy in prosthetic valve thrombosis

Thrombolytic therapy as first line treatment in prosthetic mitral valve thrombosis

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