Fibrinolytic therapy in left side-prosthetic valve acute thrombosis. In depth systematic review.
BACKGROUND
Limited data are available on the impact and safety of fibrinolytic therapy (FT) in left - side prosthetic valve acute thrombosis (PVAT).


OBJECTIVE
To improve our knowledge about the FT role in left -side PVAT.


METHODS
Bibliographic search and analysis.


METHODS
MEDLINE search from January 1970 to January 2007. Studies were classified according to the evidence level recommendations of the American College of Chest Physicians and included if they had objective diagnosis of left-side PAVT and FT efficacy assessment (hemodynamic, echocardiographic or fluoroscopic improvement). New York Heart Association class was used to establish functional state. Data on clinical characteristics, diagnosis strategy, anticoagulation status, fibrinolytic and heparin regimens, cardiovascular adverse events, outcome, and follow-up were also required.


RESULTS
A systematic search produced a total of 900 references. Each abstract was analyzed according to the predetermined criteria. Thirty-two references with 904 patients constitute the subject of this analysis. Only one trial had evidence III and thirty-one evidence V. FT was more used in young female patients (64%) with prosthetic mitral valve thrombosis (77%), and clinical instability (82%). Transesophageal echocardiogram had a higher thrombus detection rate (100%). Although several fibrinolytic regimens were used in a first or second course, streptokinase was the most frequent agent (61%). Clinical improvement was observed in 86% of the patients, objective success in 78%, and failure in 14%. Rescue fibrinolysis was done in 17%.


RESULTS
peripheral and cerebral embolism rate was 5% and 4%, respectively. Major bleeding 4% and intracranial hemorrhage 1%.


CONCLUSIONS
The available evidence demonstrates that in PVAT fibrinolytic therapy improves the outcome in younger, more ill patients, especially females, independently of the fibrinolytic regimen used with a low complications rate.
Reyes-Cerezo
Esteban
E
Emergency Care Department, Hospital de Cardiología UMAE 34, Centro Médico del Norte, IMSS, Monterrey City, Nuevo León, México.
Jerjes-Sánchez
Carlos
C
Archondo-Arce
Tamara
T
García-Sosa
Anabel
A
Garza-Ruiz
Angel
A
Ramírez-Rivera
Alicia
A
Ibarra-Pérez
Carlos
C
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006349:Heart Valve Diseases / Q000188:drug therapy* / Q000209:etiology*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology*; D055815:Young Adult