High prevalence of silent brain infarction in patients presenting with mechanical heart valve thrombosis.
BACKGROUND
Symptomatic thromboembolic events including stroke occur frequently in patients with mechanical heart valves, particularly among those who are poorly anticoagulated.


OBJECTIVE
This study set out to determine the prevalence of silent brain infarction (SBI) in this population.


METHODS
This was a post hoc analysis of data from a randomized controlled trial carried out in a tertiary-care academic medical center. The trial included participants from a randomized controlled trial of fibrinolytic therapy (FT) in patients with left-sided prosthetic valve thrombosis (PVT), who had undergone pre-treatment computed tomography (CT) scans of the brain. The prevalence of SBI in this population was investigated.


METHODS
Prevalence of silent brain infarction.


RESULTS
Silent brain infarction was present in 27 of 72 patients (37.5%; 95% confidence interval [CI] 27.2, 49.1). Most patients with SBI (57; 82.6%) had sub-therapeutic anticoagulation at presentation. We identified baseline characteristics that were associated with the presence of SBI using a logistic regression model. Atrial fibrillation (AF) was strongly associated with the presence of SBI (odds ratio [OR] 5.60; 95% CI 1.32, 23.87; p = 0.02).


CONCLUSIONS
The high prevalence of SBI among this cohort of young patients with mechanical heart valves is alarming and calls for urgent efforts to improve the quality of anticoagulation.


BACKGROUND
Registered in the US National Institutes of Health registry at http://clinicaltrials.gov as NCT00232622.
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Parag
P
Barwad
Amol
A
Raheja
Raghunandan
R
Venkat
Shyam S
SS
Kothari
Vinay
V
Bahl
Ganesan
G
Karthikeyan
D000046:Academic Medical Centers; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D020520:Brain Infarction / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D013927:Thrombosis / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D000925:Anticoagulants; D005343:Fibrinolytic Agents