THROMBOLYTIC THERAPY IN PROSTHETIC VALVE THROMBOSIS; EFFICACY AND OUTCOME
Keywords:Fibrinolysis, Prosthesis, Thrombosis, Valves
Objective: To determine the efficacy of thrombolytic therapy and its complications in PVT.
Study Design: Prospective cross-sectional study.
Place and Duration of Study: Study was conducted at AFIC/NIHD Rawalpindi from first Jan 2016 to Dec 2017.
Material and Methods: A total of 51 patients admitted with Prosthetic valve thrombosis PVT were enrolled in this study, through non-consecutive sampling technique. The primary outcome was complete response to thrombolytic therapy. The secondary outcome was a composite of death, Central nervous system CNS embolism, non CNS systemic embolism or major bleeding.
Results: Mean age was 40.88 (± 11.72). Twenty (43.13%) were male while 29 (56.86%) were female. Mitral PV was involved in 40 (78.4%) and aortic in 11 (21.6%). About 21 (41.2%) were in NYHA-I class and 29 (58.8%) in NYHAIII/ IV class. All had bileaflet valve with involvement of one leaflet in 36 (70.6%) and both leaflet in 15 (29.4%). International normalized ratio INR was sub therapeutic in 37 (72.5%). Complete response was observed in 24
(47.05%) while secondary outcome was seen in 15 (29.41%) with death in 13 (25.49%) and CNS embolism in 2 (3.92%). There was no case of non-CNS embolism or major bleeding. Complete responses varied with the severity of patient and was 14 (66.66%) in NYHA–I/II and 10 (28.57%) in NYHA-III/IV, with p-value 0.044.
Conclusion: This study reveals the burden of prosthetic valve thrombosis in a developing country. It also reveals a high mortality and a suboptimal response to thrombolytic therapy. This study also underscores the advanced stage in which patients present.