The efficacy and safety of thrombolytic agents for patients with prosthetic valve thrombosis

IF 0.2 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of the Practice of Cardiovascular Sciences Pub Date : 2022-01-01 DOI:10.4103/jpcs.jpcs_54_21
Vinoda Sharma, Brig K. Arora, L. Gupta, Amitabh Poonia, Sukriti Raina, U. Yadav, Ruchi Sharma, S. Dwivedi
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Abstract

Introduction: Prosthetic valve thrombosis (PVT) is a serious complication seen with mechanical prosthetic cardiac valves and is associated with high mortality. Emergency surgery (thrombectomy or valve replacement) had been the traditional treatment, but now with intravenous thrombolytic therapy as an alternative to emergency surgery in patients with PVT has shown excellent success rate and acceptable risk. This study is aimed to determine efficacy and safety of use of thrombolytic agents (tPA or STK) in patients with PVT. Materials and Methods: This was a retrospective, single-center study of patients with PVT admitted between 2004 and 2020 at a tertiary care center in North India. The diagnosis of PVT was based on a history of prosthetic heart valve replacement, clinical presentation, and by diagnostic methods. All patients received either tenecteplase or streptokinase given as a bolus dose of 2.5 lac units over ½ h, followed by 1 lac units/h for 24–48 h depending on clinical response and complication, whereas tenecteplase (1 mg/kg of body weight) was given as bolus. Results: Of 72 patients, 45 patients received t-PA as a thrombolytic drug. Complete success was obtained in 39 patients (86.66%), whereas partial success in 3 (17.77%) and failure in 3 (6.66%). Among the patients who received streptokinase (n = 27), complete success was found in 23 patients (85.19%), whereas partial success was seen in 3 (11.11%) and failure was seen in 1 patient (3.7%). Conclusion: Thrombolysis is a reasonable option in patients with PVT. Our study has reiterated that major factors for PVT are warfarin poor compliance and subtherapeutic international normalized ratio. Postclosure clinical follow-up along with patient education should be followed in patients with mechanical prosthetic valve.
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溶栓药物治疗人工瓣膜血栓的疗效和安全性
引言:人工瓣膜血栓形成(PVT)是机械人工心脏瓣膜的一种严重并发症,与高死亡率有关。急诊手术(血栓切除术或瓣膜置换术)曾是传统的治疗方法,但现在静脉溶栓治疗作为PVT患者急诊手术的替代方案,显示出良好的成功率和可接受的风险。本研究旨在确定溶栓剂(tPA或STK)在PVT患者中的疗效和安全性。材料和方法:这是一项对2004年至2020年间在北印度一家三级护理中心入院的PVT患者的回顾性单中心研究。PVT的诊断基于人工心脏瓣膜置换术的病史、临床表现和诊断方法。所有患者均接受替萘普酶或链激酶,在½小时内以2.5 lac单位的推注剂量给药,然后根据临床反应和并发症以1 lac单位/小时的剂量给药24-48小时,而替萘普蛋白酶(1 mg/kg体重)则以推注形式给药。结果:72例患者中,45例接受t-PA溶栓治疗。完全成功39例(86.66%),部分成功3例(17.77%),失败3例(6.66%)。在接受链激酶治疗的患者中,23例(85.19%)完全成功,3例(11.11%)部分成功,1例(3.7%)失败。我们的研究重申,PVT的主要因素是华法林依从性差和亚治疗国际标准化比率。机械人工瓣膜患者应遵循闭合后临床随访和患者教育。
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来源期刊
Journal of the Practice of Cardiovascular Sciences
Journal of the Practice of Cardiovascular Sciences CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
0.00%
发文量
29
审稿时长
11 weeks
期刊最新文献
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