title: [Prosthetic valve thrombosis: which is the most appropriate initial therapy?].
abstract: OBJECTIVE
  This study aims to investigate what is the best initial therapy for patients with obstructive prosthetic valve thrombosis.
  
  
  METHODS
  Data from 47 patients diagnosed with prosthetic valve thrombosis in two tertiary hospitals during an 8-years period were analyzed.
  
  
  RESULTS
  The involved prostheses were in mitral position in 34 cases (2 biological valves), in aortic position in 12, and in double mitral and aortic position in one. The thrombosis was not obstructive in 12 patients. In the remaining 35 patients, the prosthetic obstruction was treated by heparin (n = 2), thrombolysis (n = 19), or direct surgery (n = 14). There was no mortality in the thrombolytic group, although 6 patients needed surgery before discharge because of an abnormal prosthetic residual gradient (n = 5) or a persisting abnormal disc valve motion (n = 1). Five out of 14 patients of direct surgery died, 2 before the planned operation could be performed. Thus, mortality rate, in an intention to treat analysis, was very favourable to thrombolytic therapy (p = 0.008); and this, despite the higher index of clinical severity (on a scale from 0 to 4) was superior in this group of thrombolyzed patients: 3.3 0.6 vs. 2.1 0.9 in those who underwent surgery; p < 0.0001.
  
  
  CONCLUSIONS
  In terms of mortality rate, thrombolysis is a better alternative than direct surgery to fight against obstructive prosthetic valve thrombosis. Even if the result is suboptimal, it allows the performance of surgery in better clinical conditions and, thus, with minor risk.
authors.affiliation: Servicios de Cardiología de los Hospitales Virgen de las Nieves de Granada y aCarlos de Haya Málaga. jazpitarte@eresmas.com
authors.forename: J
authors.initials: J
authors.lastname: Azpitarte
authors.forename: J
authors.initials: J
authors.lastname: Sánchez-Ramos
authors.forename: T
authors.initials: T
authors.lastname: Urda
authors.forename: R
authors.initials: R
authors.lastname: Vivancos
authors.forename: J M
authors.initials: JM
authors.lastname: Oyonarte
authors.forename: F
authors.initials: F
authors.lastname: Malpartida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001021:Aortic Valve; D002648:Child; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology*