Efficacy and safety of thrombolytic therapy in prosthetic valve thrombosis

Authors

  • Purushotama T. S. Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Science Research (SJICSR) Centre, Mysore, Karnataka, India
  • Sathish K. Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Science Research Centre, Bangalore, Karnataka, India
  • Santhosh K. Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Science Research (SJICSR) Centre, Mysore, Karnataka, India
  • Ravindranath K. S. Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Science Research Centre, Bangalore, Karnataka, India
  • Manjunath C. N. Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Science Research Centre, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20200238

Keywords:

Prosthetic valve thrombosis, Streptokinase, Thrombosis, Thrombolytic treatment

Abstract

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.

References

Grunkemeier GL, Li HH, Naftel DC, Starr A, Rahimtoola SH. Long-term performance of heart valve prostheses. Curr Probl Cardiol. 2000;25(2):78-147.

Cannegieter S, Rosendaal F, Briet E. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation. 1994;89:635-41.

Hermans H, Vanassche T, Herijgers P, Meuris B, Herregods M-C, Van de Werf F, et al. Antithrombotic therapy in patients with heart valve prostheses. Cardiol Revi. 2013;21:27-36.

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.

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

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

Edmunds Jr LH. Thromboembolic complications of current cardiac valvular prostheses. Anna Thorac Surg. 1982;34:96-106.

Martinell J, Jimenez A, Rabago G, Artiz V, Fraile J, Farre J. Mechanical cardiac valve thrombosis. Is thrombectomy justified? Circulation. 1991;84:III70-5.

Das M, Twomey D, Khaddour AA, Dunning J. Is thrombolysis or surgery the best option for acute prosthetic valve thrombosis? Interact Cardiovascul Thorac Surg. 2007;6:806-11.

Melandri G, Vagnarelli F, Calabrese D, Semprini F, Nanni S, Branzi A. Review of tenecteplase (TNKase) in the treatment of acute myocardial infarction. Vascul Healt Risk Managem. 2009;5:249.

Kontos Jr GJ, Schaff HV, Orszulak TA, Puga FJ, Pluth JR, Danielson GK. Thrombotic obstruction of disc valves: clinical recognition and surgical management. Annal Thorac Surg. 1989 Jul 1;48(1):60-5.

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 Press;100:80.

Patil SN, Ramalingam R, Rudrappa MMB, Manjunath CN. Study of prosthetic heart valve thrombosis and outcomes after thrombolysis. Int J Res Med Sci. 2019;7:1074-8.

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;140:906-16.

Dangas GD, Weitz JI, Giustino G, Makkar R, Mehran R. Prosthetic heart valve thrombosis. Journal of the Am Colleg of Cardiol. 2016;68:2670-89.

Lengyel M, Horstkotte D, Voller H, Mistiaen W. Working Group Infection, Thrombosis, Embolism and Bleeding of the Society for Heart Valve Disease. Recommendations for the management of prosthetic valve thrombosis. J Heart Valve Dis 2005;14:567-75.

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;78:309-17.

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

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

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

Sharma V, Singh R, Mishra R, Arora A, Gupta L, Yadava O. Use of tenecteplase for left-sided prosthetic valve thrombosis. JAPI 2012;60:55-8.

Özkan M, Kaymaz C, Kirma C, Sönmez K, Özdemir N, Balkanay M, et al. Intravenous thrombolytic treatment of mechanical prosthetic valve thrombosis: a study using serial transesophageal echocardiography. J Am Colleg Cardiol. 2000;35:1881-9.

Downloads

Published

2020-01-27

How to Cite

S., P. T., K., S., K., S., S., R. K., & N., M. C. (2020). Efficacy and safety of thrombolytic therapy in prosthetic valve thrombosis. International Journal of Research in Medical Sciences, 8(2), 575–579. https://doi.org/10.18203/2320-6012.ijrms20200238

Issue

Section

Original Research Articles