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

Caceres-Loriga, Fidel Manuel; Pérez-López, Horacio; Morlans-Hernández, Karel; Facundo-Sánchez, Humberto; Santos-Gracia, José; Valiente-Mustelier, Juan; Rodiles-Aldana, Felipe; Marrero-Mirayaga, Maria Acelia; Betancourt, Blas Y; López-Saura, Pedro

doi:10.1007/s11239-006-4969-y

Cited by 95 publications

(57 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In general, TT for the treatment of PVT in nonpregnant patients is successful in ≈85% of patients. [36][37][38][39][40][41][42][43] On the other hand, our protocol demonstrated a complete success rate among all pregnant patients with PVT. This could be explained by the fresh and rapid development of clot in this specific patient population compared with nonpregnant patients with gradually developed and organized thrombus.…”

Section: Discussionmentioning

confidence: 99%

Thrombolytic Therapy for the Treatment of Prosthetic Heart Valve Thrombosis in Pregnancy With Low-Dose, Slow Infusion of Tissue-Type Plasminogen Activator

et al. 2013

View full text Add to dashboard Cite

P regnancy is associated with increased risk of thrombosis among women with mechanical prosthetic heart valves. 1 The largest literature review of women with a prosthetic heart valve who were on anticoagulation during pregnancy reported that thromboembolic complications occurred in 3.9% of women taking only warfarin, 9.2% of women who received unfractionated heparin in the first trimester followed by warfarin, and one fourth of women treated with unfractionated heparin throughout their pregnancy. Maternal death was observed in these groups in 2%, 4%, and 15%, respectively, and was usually related to prosthetic valve thrombosis (PVT).2 Similarly, 15% of pregnant women developed PVT while using low-molecular-weight heparin. The guidelines suggest optimizing anticoagulation in noncritically ill patients with recent subtherapeutic anticoagulation. Surgery is recommended when anticoagulation fails, for critically ill patients with obstructive thrombosis, or for patients with large (≥10 mm) nonobstructive PVT complicated by embolism. Fibrinolysis is recommended for either critically ill patients when Background-Prosthetic valve thrombosis during pregnancy is life-threatening for mother and fetus, and the treatment of this complication is unclear. Cardiac surgery in pregnancy is associated with very high maternal and fetal mortality and morbidity. Thrombolytic therapy has rarely been used in these patients. The aim of this study is to evaluate the safety and efficacy of low-dose (25 mg), slow infusion (6 hours) of tissue-type plasminogen activator for the treatment of prosthetic valve thrombosis in pregnant women. Methods and Results-Between 2004 and 2012, tissue-type plasminogen activator was administered to 24 consecutive women in 25 pregnancies with 28 prosthetic valve thrombosis episodes (obstructive, n=15; nonobstructive, n=13). Mean age of the patients was 29±6 years. Thrombolytic therapy sessions were performed under transesophageal echocardiography guidance. The mean dose of tissue-type plasminogen activator used was 48.7±29.5 mg (range, 25-100 mg). All episodes resulted in complete thrombus lysis after thrombolytic therapy. One patient had placental hemorrhage with preterm live birth at the 30th week, and 1 patient had minor bleeding. Conclusions-Low-dose, slow infusion of tissue-type plasminogen activator with repeated doses as needed is an effective therapy with an excellent thrombolytic success rate for the treatment of prosthetic valve thrombosis in pregnant women. This protocol also seems to be safer than cardiac surgery or any alternative medical strategies published to date. Thrombolytic therapy should be considered first-line therapy in pregnant patients with prosthetic valve thrombosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Thrombolytic Therapy for the Treatment of Prosthetic Heart Valve Thrombosis in Pregnancy With Low-Dose, Slow Infusion of Tissue-Type Plasminogen Activator

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Nonetheless, the asymptomatic patient with stable LV dimensions and excellent exercise capacity can be safely observed. 116 …”

Section: Iia Bmentioning

confidence: 99%

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Nishimura¹,

Otto²,

et al. 2017

View full text Add to dashboard Cite

“…Thrombotic obstruction on the valve replacement is a very rare but very serious complication with an incidence reported from 0.03 % to 4.3 % per patient yearly (3, 5, 7). There are a lot of causes that can induce the origin of this occlusion -most frequent is an inadequate anticoagulant therapy, then a history of thromboembolism, hypercoagulable states, mitral valve replacement, left atrial diameter > 50 mm, LVEF < 35 %, atrial fibrillation, congenital heart anomalies, infection, dehydration, pregnancy and noncompliance with anticoagulant medication (1,8). Various valve prostheses have different thrombogenicity: low risk (Carbomedics in aortic position, St Jude Medical, Medtronic Hall and recommended target INR is 2.5), medium (Bjork-Shiley, other bileaflet valves and optimal target INR is 3.0), high risk (Lillehei-Kaster, Omniscience, StarrEdwards and recommended target INR is 3.5) (9).…”

Section: Discussionmentioning

confidence: 99%

Thrombolytic Treatment of Thrombosis on the Aortic Valvular Prosthesis Complicated by Brain Embolism

Horáková

Pudil

Raupach

et al. 2008

Acta Med. (Hradec Kralove, Czech Repub.)

View full text Add to dashboard Cite

Summary:The authors present a case of thrombosis on the St. Jude Medical 19 aortic valve prosthesis. The diagnosis was confirmed by transthoracic and transoesofageal echocardiography, cardiac fluoroscopy revealed restricted movement of the aortic valve prosthesis leaflet. Thrombolytic therapy was complicated with brain embolism that was successfully percutaneously removed from the cerebral artery by the mechanical device. The patient has fully recovered without any neurological residual symptoms. This case report should be instructive to other clinicians who encounter the same complications after thrombolytic treatment.

show abstract

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

Cited by 95 publications

References 24 publications

Thrombolytic Therapy for the Treatment of Prosthetic Heart Valve Thrombosis in Pregnancy With Low-Dose, Slow Infusion of Tissue-Type Plasminogen Activator

Thrombolytic Therapy for the Treatment of Prosthetic Heart Valve Thrombosis in Pregnancy With Low-Dose, Slow Infusion of Tissue-Type Plasminogen Activator

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Thrombolytic Treatment of Thrombosis on the Aortic Valvular Prosthesis Complicated by Brain Embolism

Contact Info

Product

Resources

About