title: Non-obstructive prosthetic heart valve thrombosis (NOPVT): Really a benign entity?
abstract: OBJECTIVE
  To assess the effectiveness of different treatment strategies in patients with non-obstructive prosthetic valve thrombosis (NOPVT) during hospitalization and long-term follow-up.
  
  
  METHODS
  NOPVT was diagnosed by transesophageal echocardiography. Resolution was defined as the disappearance or reduction of the thrombus under anticoagulation. All cases were first managed with optimization of anticoagulation. At discharge, patients received oral anticoagulation (OAC) alone or OAC and antiplatelet therapy (double treatment). Adverse events were defined as cardiovascular death, recurrence, thromboembolic events or major bleeding.
  
  
  RESULTS
  From 1997 to 2012, 47 patients (mean age: 65years; women: 60%) were diagnosed with NOPVT (mitral valve: 97%). Previous poor anticoagulation control was documented in 66% of patients. Twenty-one patients (45%) were treated with unfractionated heparin (UFH), especially those with thrombus size >10mm (19/21). Optimization of OAC was performed in the remaining patients. Treatment failed in 13 (27.6%) patients, mostly in those who received UFH (10/13), requiring surgery (53.8%) or fibrinolysis (30.7%). Forty-two patients survived and, at discharge, 44% of patients received OAC alone and 56% the double treatment. At follow-up (median 23months; range 0.03-116months), 59.5% of patients presented cardiovascular events, however no differences in outcome were observed with double treatment or OAC alone (p=0.385).
  
  
  CONCLUSIONS
  NOPVT is a high-risk complication, not only during hospitalization but also during follow-up. Optimization of anticoagulation is efficient in most patients except in thrombi ≥10mm treated with UFH. The double treatment does not prevent adverse events or complications during follow-up.
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: mariamutuber@gmail.com.
authors.forename: María
authors.initials: M
authors.lastname: Mutuberría-Urdaniz
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: José F
authors.initials: JF
authors.lastname: Rodríguez-Palomares
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bañeras
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Gisela
authors.initials: G
authors.lastname: Teixidó
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Gutiérrez
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: German
authors.initials: G
authors.lastname: Zavala
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Maria T
authors.initials: MT
authors.lastname: González-Alujas
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Artur
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Tornos
authors.affiliation: Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D013923:Thromboembolism / Q000209:etiology; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Anticoagulation; Cardiovascular event; Echocardiography; Embolus; Prosthetic heart valve; Thrombosis