SHORT-COURSE THROMBOLYSIS AS THE FIRST-LINE OF THERAPY FOR CARDIAC-VALVE THROMBOSIS

Objective: To retrospectively evaluate the clinical and echocardiograp hic criteria of thrombolytic therapy for mechanical heart valve thromb osis, Methods: Nineteen consecutive patients with 22 instances of pros thetic heart valve thrombosis (14 mitral, 2 aortic, 3 tricuspid, and 3 pulmonary) were treated with short-course thrombolytic therapy as fir st option of treatment in absence of contraindications. The thrombolyt ic therapy protocol consisted of streptokinase (1,500,000 IU in 90 min utes) (n = 18) in one (n = 7) or two (n = 11) cycles or recombinant ti ssue-type plasminogen activator (100 mg in 90 minutes) (n = 4), Result s: Overall success was seen in 82%, immediate complete success in 59%, and partial success in 23%, Six patients without total response to th rombolytic therapy underwent surgery, and pannus was observed in 83%, Sis patients showed complications: allergy, stroke, transient ischemic attack, coronary embolism, minor bleeding, and one death. At diagnosi s, 10 patients evidenced atrial thrombus by transesophageal echocardio graphy, 3 of whom experienced peripheral embolism during thrombolysis. Four episodes of rethrombosis were observed (16%), The survivorship w as 84% with a mean follow-up of 42.6 months. Conclusions: A short-cour se of thrombolytic therapy may be considered first-line therapy for pr osthetic heart valve thrombosis. The risk of peripheral embolism may b e evaluated for the presence of atrial thrombus by transesophageal ech ocardiography at diagnosis.