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Thrombolysis as first choice therapy in prosthetic heart valve thrombosis. A study of 68 patients

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Abstract

Background and objectives: Valvular thrombosis is a serious complication in patients with prosthetic heart valves. Traditional treatment is emergency surgery, but thrombolysis provides a non invasive alternative. In this paper we evaluate the efficacy and safety of thrombolysis in prosthetic heart valve thrombosis.

Methods: Data of 68 patients diagnosed of prosthetic valve thrombosis, treated at the Institute of Cardiology and Cardiovascular Surgery, Havana during a 6-years period were analyzed. They received thrombolysis with a recombinant streptokinase infusion at 250 000 IU in 30 minutes followed by 100 000 IU/hour during 72 hours or less if the thrombosis resolved before. The evaluation was based on clinical and echocardiographic findings.

Results: Affected sites were mitral (50 cases), tricuspid (9), and aortic (9). Mean time of prosthesis implantation was 6.8 years. The presentation form was generally heart failure (NYHA functional class III–IV) in 64 (94.1%) patients. Mean time interval between onset of symptoms and diagnosis was 10.6 days. There was total response to treatment in 58 (85.3%) patients, partial in 4 (5.9%) and failure in 6 (8.8%). Recombinant streptokinase overall dose was 5.1 × 106 IU and mean infusion time 50 hours. Major hemorrhagic complications were observed in two patients. Five embolic events occurred during thrombolysis. Four patients died. Rethrombosis was noted in 11 patients; 10 were retreated successfully with thrombolysis.

Conclusions: Thrombolysis with recombinant streptokinase is efficacious and safe for the treatment of prosthetic heart valve thrombosis. It does not contraindicate surgical treatment if there is no total response, because patient goes to surgery in better hemodynamic conditions with lower risk. Nowadays it can be considered as first-line treatment in all patients with prosthetic heart valve thrombosis regardless of functional class unless specific contraindications exist.

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Authors and Affiliations

  1. Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba

    Fidel Manuel Cáceres-Lóriga, Horacio Pérez-López, Karel Morlans-Hernández, José Santos-Gracia, Juan Valiente-Mustelier & Felipe Rodiles-Aldana

  2. Hermanos Ameijeiras Clinical-Surgical Hospital, Havana, Cuba

    Humberto Facundo-Sánchez

  3. Nacional Centre for Clinical Trials Coordination, Havana, Cuba

    Maria Acelia Marrero-Mirayaga

  4. Clinical Trials Division, Centre for Biological Research, Havana, Cuba

    Blas Y. Betancourt & Pedro López-Saura

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  1. Fidel Manuel Cáceres-Lóriga
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  2. Horacio Pérez-López
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  3. Karel Morlans-Hernández
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  4. Humberto Facundo-Sánchez
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  7. Felipe Rodiles-Aldana
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  10. Pedro López-Saura
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Correspondence to Fidel Manuel Cáceres-Lóriga.

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Cáceres-Lóriga, F.M., Pérez-López, H., Morlans-Hernández, K. et al. Thrombolysis as first choice therapy in prosthetic heart valve thrombosis. A study of 68 patients. J Thromb Thrombolysis 21, 185–190 (2006). https://doi.org/10.1007/s11239-006-4969-y

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  • DOI: https://doi.org/10.1007/s11239-006-4969-y

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