FIBRINOLYTIC TREATMENT OF PROSTHETIC VALVE THROMBOSIS: A SINGLE-CENTER STUDY OF 72 CASES

Objectives: To analyze the results of fibrinolysis in a large single-center group of patients with prosthetic heart valve thrombosis. Methodology: This descriptive study was conducted at Rehman Medical Institute Peshawar, Pakistan. A total of 72 consecutive patients presenting with Prosthetic heart valve thrombosis received Fibrinolysis treatment between 2003 and 2008. The diagnosis of Prosthetic heart valve thrombosis was established mainly by echocardiography. The fibrinolytic agent used was streptokinase. The outcome of Fibrinolysis treatment was assessed through hemodynamic parameters via echocardiography and also on clinical grounds. Results: Complete success of hemodynamic abnormalities was noted in 61 of 72 patients, partial resolution in 6/72 patients, and failure in 5/72 patients after one or more consecutive fibrinolytic regimens. Only streptokinase was used as a fibrinolytic as previous studies have clearly established its supremacy. One death was reported. Major bleed, requiring transfusion occurred in just one patient. Three documented Cerebrovascular accidents with two embolic events and one cerebral haemorrhage occurred during Fibrinolysis treatment. Conclusions: These results demonstrate that Fibrinolysis treatment is effective in Prosthetic heart valve thrombosis, regardless of prosthetic site involved. It also failed to show any significant difference between outcomes of success in different New York Heart Association classes and thus supports FT in New York Heart Association classes I and II as well.