Thrombolytic treatment of prosthetic valve thrombosis: a study using Urokinase
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(2020) 15:286
RESEARCH ARTICLE
Open Access
Thrombolytic treatment of prosthetic valve thrombosis: a study using Urokinase Feng Huang1,2, Yongrong Lan1,2, Zhangbo Cheng1,2, Zili Zhang1,2 and Fei Ren1,2*
Abstract Objective: We analysed the efficacy and safety of thrombolytic therapy with urokinase in patients with prosthetic valve thrombosis. Methods: Twenty-three patients with valve thrombosis received thrombolytic treatment using urokinase. First, a 250,000 IU intravenous bolus injection was administered as a loading dose, followed by intravenous infusion of 100, 000 IU/h for 10 h and anticoagulation with low molecular weight heparin every day. The maximum treatment time was 5 days, i.e., until the transvalvular pressure gradient was normal or close to normal. Transthoracic echocardiography (TTE) was used every 12 h to monitor whether the thrombus was reduced and whether there was haemodynamic improvement. Routine blood tests, the prothrombin time (PT), international normalized ratio (INR) and complications were observed every day. Results: Sixteen (69.6%) patients were successfully treated with thrombolytic therapy: 2/2 (100%) aortic valves and 14/21 (66.7%) mitral valves. The partial success rate of this study was 13.0% (3/23). Four patients did not show any improvement in haemodynamics. Two cases had slight urine haemorrhage. One patient died of severe cerebral haemorrhage and shock. The overall mortality was 13.0% (3/23), including two patients who died after subsequent surgery. Conclusion: Urokinase is more convenient and successful in the treatment of PVT. More experience may make TT the optimal treatment for PVT, especially in high-risk surgical situations. Keywords: Fibrinolysis, Thrombolytic treatment, Prosthetic valve thrombosis
Introduction Prosthetic valve thrombosis (PVT) is a serious complication that occurs after prosthetic heart valve replacement in patients who are poorly anticoagulated. The incidence of thromboembolic complications after mechanical valve replacement is 0.5–8%, especially in patients with poor compliance with anticoagulant therapy [1]. At present, the primary treatment for PVT includes intensive anticoagulation therapy, thrombolytic treatment (TT) and emergency surgery. Compared with that of TT, the * Correspondence: [email protected] 1 Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou 350000, China 2 Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
mortality rate of emergency surgery in PVT patients is higher. Intravenous TT has been used as an alternative treatment to surgery in PVT patients [2]. We report a single-centre retrospective study of urokinase in patients with PVT to better determine the efficacy and safety of this treatment (Table 1).
Methods Between September 2010 and March 2018, we recruited twenty-three patients treated with fibrinolytic agents whose surgical mortality was considered to be higher than the risk of catastrophic emboli. All patients were confirmed by clinical symptoms, blood examination,
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