Clinical profile of patients with prosthetic valve thrombosis treated with fibrinolysis

Abstract

Objective: Prosthetic valve thrombosis (PVT) is a potentially life-threatening complication. Fibrinolytic therapy is the first line of treatment in the developing countries mainly due to financial constraints and limited surgical availability. We performed a retrospective, single-center study to evaluate the clinical profile of patients with PVT treated with fibrinolysis. Methods: Data of 21 consecutive patients admitted with PVT and treated with fibrinolysis during 1-year study period (January 2017–January 2018) were retrospectively analyzed in terms of clinical characteristics and outcomes. Results: Out of 21 patients with 21 PVT episodes, there were 13 females (62%) and 8 males (38%) with a mean age of 35.2 ± 12.2 years (age range: 18–57 years). Presenting complaint in all patients was dyspnea with majority (90.5%) presenting in the New York Heart Association (NYHA) Class III/IV. Subtherapeutic international normalized ratio (<2.5) was found in 19 (90.5%) patients. Nineteen (90.5%) PVT episodes occurred in mitral position alone and two (9.5%) in both mitral and aortic. All patients were thrombolyzed with streptokinase with complete clinical success in 16 (76.2%), partial clinical success in 2 (9.5%), and inhospital mortality in 3 (14.3%) patients. Complications occurred in three (14.3%) patients, including one (4.8%) major (embolic stroke) and two (9.5%) minor (per vaginal bleed). Conclusions: Left-sided PVT is more common in mitral position than aortic with subtherapeutic anticoagulation being the major risk factor. Fibrinolysis can be considered as an effective and acceptable alternative to surgery, even for patients presenting with NYHA Class III/IV, especially in developing countries or in centers with limited resources.