Clinical profile, management strategy, and outcomes of patients with prosthetic valve thrombosis

Abstract

Background: Prosthetic valve thrombosis (PVT) is a severe complication following prosthetic heart valve replacement, particularly in inadequately anticoagulated patients. Primary treatment options include intensive anticoagulation therapy, thrombolytic treatment (TT), and emergency surgery. This study aims to evaluate the clinical profile, management strategies, and short-term outcomes of patients with PVT.

Methodology: Consecutive patients with PVT presenting to the emergency department of a tertiary care cardiac center were included in this study. Responses to treatment, hospital outcomes, and 30-day outcomes post-treatment were observed.

Results: A total of 75 patients were analyzed, with a male predominance (50.7%) and a mean age of 39.5 ± 12.3 years. Bi-leaflet prosthetic valves were most common (96.0%), 54 (72.0%) had prosthetic mitral valve and 10 (13.3%) had prosthetic both mitral and aortic valves. Atrial fibrillation was present in 25.3% of cases. Treatment predominantly involved streptokinase (74.7%), followed by heparin (37.3%) and VKA (9.3%). Clinical success was achieved in 84.0% of cases, while 12.0% experienced clinical failure, including severe complications such as irreversible neurologic damage (1.3%) and bleeding (2.8%). The 30-day mortality rate was 12.0%, with recurring PVT and bleeding/embolic complications each in 1.5% of cases.

Conclusion: Treatment of PVT with streptokinase, heparin, and VKA demonstrates efficacy, with a substantial proportion of patients achieving complete clinical success. However, the study highlights concerning outcomes, including clinical failure and severe complications. These findings underscore the importance of carefully balancing thrombolytic and anticoagulant therapies to mitigate potential adverse events.