Study of prosthetic heart valve thrombosis and outcomes after thrombolysis

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


Background: The study aimed to evaluate the clinical presentation, diagnostic features, treatment strategies, and complications of prosthetic heart valve thrombosis (PHVT) and to determine efficacy, outcomes and complications of thrombolytic therapy during hospital stay.

Methods: This was a prospective, observational, single-centre study carried out between March, 2016 and December, 2017 at a tertiary care centre in India. Total 110 patients with history of prosthetic heart valve replacement and symptoms related to PHVT were included in the study. Patients underwent thrombolysis, surgery or conservative management for treatment of PHVT, as per their individual clinical presentation. Clinical profile and treatment outcomes were assessed using a pre-tested, semi-structured questionnaire and clinical assessment.

Results: Mean age of the patients was 39.4±12.5 years. Most of the patients presented with NYHA class II and III (85.4%) symptoms. Total 20.9% of patients were poorly compliant with anticoagulants. Thrombolysis was initial treatment in 105 (95.5%) patients. Five (4.6%) patients were treated with heparin. Two patients underwent surgery after failed thrombolysis. Mortality in the thrombolysis group was 6.6%. Embolism occurred in 8.6% of the group and major bleeding in 1.9%. One patient who underwent surgery died.

Conclusions: In light of these results, it can be concluded that most cases of PHVT are due to inadequate anticoagulation and poor monitoring mainly in patients belonging to the lower socioeconomic group. Thrombolysis can be considered as first line therapy where the immediate surgical options are remote.


Prosthetic heart valve, Streptokinase, Thrombosis, Thrombolysis

Full Text:



Biteker M, Altun I, Basaran O, Dogan V, Yildirim B, Ergun G. Treatment of prosthetic valve thrombosis: current evidence and future directions. J Clin Med Res. 2015;7(12):932.

Karthikeyan G, Math RS, Mathew N, Shankar B, Kalaivani M, Singh S, et al. Accelerated infusion of streptokinase for the treatment of left-sided prosthetic valve thrombosis: a randomized controlled trial. Circulation. 2009;120(12):1108-14.

Duran N, Biteker M, Ozkan M. Treatment alternatives in mechanical valve thrombosis. Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir. 2008;36(6):420-5.

Lim WY, Lloyd G, Bhattacharyya S. Mechanical and surgical bioprosthetic valve thrombosis. Heart. 2017;103(24):1934-41.

Krishnan S. Prosthetic heart valve thrombosis: Diagnosis and newer thrombolytic regimes. J Prac Cardiovas Sci. 2016;2(1):7.

Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93(1):137-42.

Reddy YS, Pingali K, Otikunta AN, Nathani S, Malladi SR. A study of indications, complications of prosthetic valves and prognosis after treatment of stuck valve. Blood pressure. 2017;100(70):80.

Gupta D, Kothari SS, Bahl VK, Goswami KC, Talwar KK, Manchanda SC, et al. Thrombolytic therapy for prosthetic valve thrombosis: short-and long-term results. Am Heart J. 2000;140(6):906-16.

Dangas GD, Weitz JI, Giustino G, Makkar R, Mehran R. Prosthetic heart valve thrombosis. J American Colle Cardiol. 2016;68(24):2670-89.

Lengyel M, Horstkotte D, Voller H, Mistiaen WP, Working Group Infection Thrombosis E, Disease BotSfHV. Recommendations for the management of prosthetic valve thrombosis. J Heart Valve Dis. 2005;14(5):567.

Reyes-Cerezo E, Jerjes-Sánchez C, Archondo-Arce T, García-Sosa A, Garza-Ruiz Á, Ramírez-Rivera A, et al. Fibrinolytic therapy in left side-prosthetic valve acute thrombosis. In depth systematic review. Archivos de cardiologia de Mexico. 2008;78(3):309-17.

Cáceres-Lóriga FM, Pérez-López H, Santos-Gracia J, Morlans-Hernandez K. Prosthetic heart valve thrombosis: pathogenesis, diagnosis and management. Int J Cardiol. 2006;110(1):1-6.

Sharma KH, Mewada NM. Efficacy and safety of streptokinase in prosthetic valve thrombosis (total 5 years clinical registry). Indian J Pharmacol. 2010;42(5):330.

Singh S, Doshi S, Salahuddin S, Tarik M, Barwad P, Ramakrishnan L, et al. Antistreptokinase antibodies and outcome of fibrinolytic therapy with streptokinase for left-sided prosthetic valve thrombosis. American Heart J. 2015;169(1):170-4.

Asante-Korang A, Sreeram N, McKay R, Arnold R. Thrombolysis with tissue-type plasminogen activator following cardiac surgery in children. International J Cardiol. 1992;35(3):317-22.

Witchitz S, Veyrat C, Moisson P, Scheinman N, Rozenstajn L. Fibrinolytic treatment of thrombus on prosthetic heart valves. Heart. 1980;44(5):545-54.