Document Type : Original Article
Authors
1 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Cardiology ,Chamran Cardiovascular and Medical Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
5 Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
INTRODUCTION: Valvular heart disease presents a significant and escalating global health challenge. Prosthetic valve thrombosis (PVT) following surgical valve replacement is a primary cause of valve failure. The aim of this study was to ascertain the outcomes and complications of fibrinolytic therapy in patients diagnosed with PVT.
METHOD: This cross-sectional study enrolled 81 patients diagnosed with PVT who underwent fibrinolytic therapy between 2008 and 2018. Streptokinase was administered to 87.6% of patients, while 12.4% received reteplase. All demographic and clinical data were gathered from the patients’ medical records. The incidence of successful recovery and complications were assessed.
RESULTS: The records of 81 patients (43.2% male, mean age: 51.6 ± 13.9 years) were examined. The findings revealed that 59% and 35% of the patients had mitral and aortic PVT, respectively. While 12% of the patients experienced drug complications, 90% achieved successful recovery. Stroke and severe hemorrhage were complications frequently reported by the patients treated with streptokinase (8% and 4% respectively). The patients treated with reteplase demonstrated a 100% recovery rate. Conversely, 89% of the patients treated with streptokinase achieved successful recovery, and 7% of the patients experienced a partial recovery.
CONCLUSION: Fibrinolytic agents can serve as an effective treatment with an excellent success rate for managing PVT in patients post-surgical valve replacement.
Keywords
2. Chen J, Li W, Xiang M. Burden of valvular heart disease, 1990-2017: results from the Global Burden of Disease Study 2017. J Glob Health 2020; 10(2).https://doi.org/10.7189/jogh.10.020404
3. Boudoulas KD, Borer JS, Boudoulas H. Etiology of valvular heart disease in the 21st century. Cardiology (Basel) 2013; 126(3): 139-52. https://doi.org/10.1159/000354221
4. Coffey S, Roberts-Thomson R, Brown A, Carapetis J, Chen M, Enriquez-Sarano M, et al. Global epidemiology of valvular heart disease. Nat Rev Cardiol 2021; 18(12): 853-64. https://doi.org/10.1038/s41569-021-00570-z
5. Arabloo J, Omidi N, Rezapour A, Asiabar AS, Ghorashi SM, Azari S. The burden of nonrheumatic valvular heart diseases in Iran between 1990 and 2017: Results from the global burden of disease study 2017. IJC Heart Vasc 2022; 39: 100956. https://doi.org/10.1016/j.ijcha.2022.100956
6. Bowdish ME, D’Agostino RS, Thourani VH, Desai N, Shahian DM, Fernandez FG, et al. The Society of Thoracic Surgeons adult cardiac surgery database: 2020 update on outcomes and research. Ann Thorac Surg 2020; 109(6): 1646-55. https://doi.org/10.1016/j.athoracsur.2020.03.003
7. Fiedler AG, Tolis G. Surgical treatment of valvular heart disease: overview of mechanical and tissue prostheses, advantages, disadvantages, and implications for clinical use. Curr Treat Options Cardiovasc Med 2018; 20(1): 1-13. https://doi.org/10.1007/s11936-018-0601-7
8. 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 Rev 2013; 21(1): 27-36. https://doi.org/10.1097/CRD.0b013e3182638578
9. Sharma V, Arora BYK, Gupta LC, Poonia A, Raina S, Yadav US, et al. The efficacy and safety of thrombolytic agents for patients with prosthetic valve thrombosis. J Pract Cardiovasc Sci 2022; 8(1): 30. https://doi.org/10.4103/jpcs.jpcs_54_21
10. Nawale JM, Chaurasia AS, Nalawade DD, Abdagire N. Clinical profile of patients with prosthetic valve thrombosis treated with fibrinolysis. J Pract Cardiovasc Sci 2018; 4(2): 109. https://doi.org/10.4103/jpcs.jpcs_29_18
11. Kounka Z, Roque-Rodríguez B, Lezcano-Gort LE, Chipayo-Gonzáles DA, Gallego-Curto E, Rodríguez-Carreras CR. Management of the Prosthetic Valve Thrombosis: This Time Is Different. Case Rep Clin Med 2021; 10(7): 185-90. https://doi.org/10.4236/crcm.2021.107023
12. 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. https://doi.org/10.1161/CIRCULATIONAHA.109.876706
13. Özkan M, Gündüz S, Biteker M, Astarcioglu MA, Çevik C, Kaynak E, et al. Comparison of different TEE-guided thrombolytic regimens for prosthetic valve thrombosis: the TROIA trial. JACC Cardiovasc Imaging 2013; 6(2): 206-16. https://doi.org/10.1016/j.jcmg.2012.10.016
14. Özkan M, Gündüz S, Gürsoy OM, Karakoyun S, Astarcıoğlu MA, Kalçık M, et al. Ultraslow thrombolytic therapy: A novel strategy in the management of PROsthetic MEchanical valve Thrombosis and the prEdictors of outcomE: The Ultra-slow PROMETEE trial. Am Heart J 2015; 170(2): 409-18. https://doi.org/10.1016/j.ahj.2015.04.025
15. Keuleers S, Herijgers P, Herregods M-C, Budts W, Dubois C, Meuris B, et al. Comparison of thrombolysis versus surgery as a first line therapy for prosthetic heart valve thrombosis. Am J Cardiol 2011; 107(2): 275-9. https://doi.org/10.1016/j.amjcard.2010.09.013
16. Gündüz S, Kalçık M, Gürsoy MO, Güner A, Özkan M. Diagnosis, treatment & management of prosthetic valve thrombosis: the key considerations. Expert Rev Med Devices 2020; 17(3): 209-21. https://doi.org/10.1080/17434440.2020.1733972
17. Kathirvel D, Paul GJ, Palanisamy G, Gnanavelu G, Ravishankar G, Swaminathan N, et al. Tenecteplase versus streptokinase thrombolytic therapy in patients with mitral prosthetic valve thrombosis. Indian Heart J 2018; 70(4): 506-10. https://doi.org/10.1016/j.ihj.2017.10.014
18. Abbas S, Hameed N, Khilji SA, Jalal A. Outcome of thrombolysis with streptokinase in patients with prosthetic valve thrombosis. Pakistan J Med Sci 2021; 37(2): 325. https://doi.org/10.12669/pjms.37.2.3226
19. Özkan M, Gündüz S, Güner A, Kalçık M, Gürsoy MO, Uygur B, et al. Thrombolysis or surgery in patients with obstructive mechanical valve thrombosis: the multicenter HATTUSHA study. J Am Coll Cardiol 2022; 79(10): 977-89. https://doi.org/10.1016/j.jacc.2021.12.027
20. 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. https://doi.org/10.4103/0253-7613.70403
21. Pradhan A, Bhandari M, Gupta V, Vishwakarma P, Sethi R, Narain VS, et al. Short-term clinical follow-up after thrombolytic therapy in patients with prosthetic valve thrombosis: a single-center experience. Cardiol Res 2019; 10(6): 345. https://doi.org/10.14740/cr924
22. Manandhar R, Prajapati D, Tamrakar R, Bogati A, Roka M, Sherpa K, et al. Clinical profile and management of prosthetic valve thrombosis in Tertiary cardiac Centre of Nepal, a prospective study. Nepal Heart J 2022; 19(1): 11-5. https://doi.org/10.3126/njh.v19i1.45276
23. Bagheri RK, Keihanian F, Ahmadi M, Ansari MA. Successful treatment of prosthetic pulmonary valve thrombosis with reteplase: a case report. Int Med Case Rep J 2018; 11: 205. https://doi.org/10.2147/IMCRJ.S168968
24. Behzadnia N, Abedini A, Seyedi SR, Ahmadi HZ, Zadeh FN, Fakharian A. Treatment of recurrent prosthetic mitral valve thrombosis with reteplase: a report of four cases. Tanaffos 2016; 15(2): 117.
25. Karthikeyan G, Mathew N, Math RS, Devasenapathy N, Kothari SS, Bahl VK. Timing of adverse events during fibrinolytic therapy with streptokinase for left-sided prosthetic valve thrombosis. J Thromb Thrombolysis 2011; 32(2): 146-9. https://doi.org/10.1007/s11239-011-0579-4
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