title: Thrombolysis as first choice therapy in prosthetic heart valve thrombosis. A study of 68 patients.
abstract: OBJECTIVE
  Valvular thrombosis is a serious complication in patients with prosthetic heart valves. Traditional treatment is emergency surgery, but thrombolysis provides a non invasive alternative. In this paper we evaluate the efficacy and safety of thrombolysis in prosthetic heart valve thrombosis.
  
  
  METHODS
  Data of 68 patients diagnosed of prosthetic valve thrombosis, treated at the Institute of Cardiology and Cardiovascular Surgery, Havana during a 6-years period were analyzed. They received thrombolysis with a recombinant streptokinase infusion at 250,000 IU in 30 minutes followed by 100,000 IU/hour during 72 hours or less if the thrombosis resolved before. The evaluation was based on clinical and echocardiographic findings.
  
  
  RESULTS
  Affected sites were mitral (50 cases), tricuspid (9), and aortic (9). Mean time of prosthesis implantation was 6.8 years. The presentation form was generally heart failure (NYHA functional class III-IV) in 64 (94.1%) patients. Mean time interval between onset of symptoms and diagnosis was 10.6 days. There was total response to treatment in 58 (85.3%) patients, partial in 4 (5.9%) and failure in 6 (8.8%). Recombinant streptokinase overall dose was 5.1 x 10(6) IU and mean infusion time 50 hours. Major hemorrhagic complications were observed in two patients. Five embolic events occurred during thrombolysis. Four patients died. Rethrombosis was noted in 11 patients; 10 were retreated successfully with thrombolysis.
  
  
  CONCLUSIONS
  Thrombolysis with recombinant streptokinase is efficacious and safe for the treatment of prosthetic heart valve thrombosis. It does not contraindicate surgical treatment if there is no total response, because patient goes to surgery in better hemodynamic conditions with lower risk. Nowadays it can be considered as first-line treatment in all patients with prosthetic heart valve thrombosis regardless of functional class unless specific contraindications exist.
authors.affiliation: Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba. caceresm@infomed.sld.cu
authors.forename: Fidel Manuel
authors.initials: FM
authors.lastname: Cáceres-Lóriga
authors.forename: Horacio
authors.initials: H
authors.lastname: Pérez-López
authors.forename: Karel
authors.initials: K
authors.lastname: Morlans-Hernández
authors.forename: Humberto
authors.initials: H
authors.lastname: Facundo-Sánchez
authors.forename: José
authors.initials: J
authors.lastname: Santos-Gracia
authors.forename: Juan
authors.initials: J
authors.lastname: Valiente-Mustelier
authors.forename: Felipe
authors.initials: F
authors.lastname: Rodiles-Aldana
authors.forename: Maria Acelia
authors.initials: MA
authors.lastname: Marrero-Mirayaga
authors.forename: Blas Y
authors.initials: BY
authors.lastname: Betancourt
authors.forename: Pedro
authors.initials: P
authors.lastname: López-Saura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013300:Streptokinase / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase