Thrombolysis realistic alternative to surgery for prosthetic valve thrombosis
MedWire News: Thrombolysis compares favorably to surgery as a first-line treatment for patients with prosthetic valve thrombosis (PVT), Belgian researchers report.
In their study of 31 patients (mean age 59 years, 19% men) with PVT, Tom Adriaenssens and colleagues from University Hospitals Leuven observed similar death and recurrence rates among patients treated with thrombolysis using recombinant tissue plasminogen activator (rt-PA) plus heparin and those treated with surgery at a single center over a 21-year period.
PVT is one of the most serious long-term complications after heart valve replacement, and optimal treatment remains unclear because of a lack of randomized controlled trials and the relative rarity of the condition, explain the researchers.
Analysis of patients' records showed that the time interval between valve replacement and thrombosis ranged from 3 months to 32 years, with a median of 11 years.
Mitral valves were most commonly affected (n=17), followed by aortic (n=8), and tricuspid (n=6) valves.
In total, 18 patients underwent surgery and 13 were treated with thrombolysis.
Among the patients who underwent surgery, two (11%) deaths occurred in the immediate perioperative period and two (11%) recurrences occurred during a median follow-up period of 76 months.
The researchers report that 12 (92%) patients in the thrombolysis group showed immediate clinical improvement after a single administration of rt-PA, of whom eight (62%) showed complete response with normalization of echocardiographic findings.
Four (31%) patients showed partial response with clinical improvement but incomplete resolution of valve dysfunction on echocardiography, while the only nonresponder was subsequently referred for urgent surgery.
During a median follow-up period of 18 months, four (31%) thrombolysis patients had PVT recurrence, and one patient, who refused further anticoagulation treatment 1 week after successful thrombolysis, died.
Stroke, transient ischemic attack, and hemorrhage each occurred in one thrombolysis patient, while two patients experienced peripheral embolic events that resolved spontaneously.
"Historically, surgery has always been considered the treatment of choice for PVT, and thrombolysis has been proposed as a noninvasive alternative," remark Adriaenssens and co-authors in the American Journal of Cardiology.
"In our experience, fibrinolysis with rt-PA is highly effective in obstructive PVT, with complete resolution after a single administration of rt-PA in 62% of patients and a significant clinical improvement in 92%," they conclude.
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By Laura Dean