High Prevalence of Silent Brain Infarction in Patients Presenting with Mechanical Heart Valve Thrombosis

Abstract

Symptomatic thromboembolic events including stroke occur frequently in patients with mechanical heart valves, particularly among those who are poorly anticoagulated. This study set out to determine the prevalence of silent brain infarction (SBI) in this population. 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. Prevalence of silent brain infarction. 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). 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. Registered in the US National Institutes of Health registry at http://clinicaltrials.gov as NCT00232622.