title: Prolonged Infusions of Low-Dose Thrombolytics in Elderly Patients With Prosthetic Heart Valve Thrombosis.
abstract: BACKGROUND
  The outcomes of thrombolytic therapy (TT) in elderly patients with prosthetic valve thrombosis (PVT) have not been evaluated previously. We investigated the outcomes of low-dose and slow infusion TT strategies in elderly patients with PVT.
  
  
  METHODS
  Twenty-seven (19 female) patients aged ≥65 years (median: 70 years, range: 65-82 years) were treated with repeated TT agents for PVT. The TT regimens included 24-hour infusion of 1.5 million units of streptokinase in 2 patients, 6-hour infusion of 25 mg recombinant tissue plasminogen activator (t-PA) in 12 patients, and 25-hour infusion of 25 mg t-PA in 13 patients. Treatment success and adverse event rates were assessed.
  
  
  RESULTS
  The initial and cumulative success rates were 40.7% and 85.2%, respectively. Adverse events occurred in 6 (22.2%) patients including 4 (14.8%) major (1 death, 1 rethrombosis, and 2 failed TT) and 2 (7.4%) minor (1 transient ischemic attack and 1 access site hematoma) events. Higher thrombus burden (thrombus area ≥1.1 cm2by receiver operating characteristics analysis, sensitivity: 83.3%, specificity: 85%, area under the curve: 0.86, P = .008) and New York Heart Association class (0% vs 15.4% vs 25% vs 100% for classes I-IV, respectively, P = .02) predicted adverse events. By multiple variable analysis, thrombus area was the only independent predictor of adverse events (odds ratio: 13.8, 95% confidence interval: 1.02-185, P = .04).
  
  
  CONCLUSIONS
  Slow infusion of low doses of TT agents (mostly t-PA) with repetition is successful and safe in elderly patients with PVT. However, excessive thrombus burden may predict adverse events.
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Gündüz
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Özkan
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Yesin
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Macit
authors.initials: M
authors.lastname: Kalçık
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mustafa Ozan
authors.initials: MO
authors.lastname: Gürsoy
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Karakoyun
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Astarcıoğlu
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ahmet Çağrı
authors.initials: AÇ
authors.lastname: Aykan
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gökdeniz
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Biteker
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Nilüfer Ekşi
authors.initials: NE
authors.lastname: Duran
authors.affiliation: 1 Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yıldız
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D013300:Streptokinase / Q000008:administration & dosage; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator
keywords: cardiology; thrombolytics; thrombosis