Author + information
- Received July 6, 2012
- Revision received October 2, 2012
- Accepted October 4, 2012
- Published online February 1, 2013.
- Mehmet Özkan, MD⁎,⁎ (, )
- Sabahattin Gündüz, MD⁎,
- Murat Biteker, MD⁎,
- Mehmet Ali Astarcioglu, MD⁎,
- Cihan Çevik, MD†,
- Evren Kaynak, MD‡,
- Mustafa Yıldız, MD, PhD⁎,
- Emrah Oğuz, MD⁎,
- Ahmet Çağrı Aykan, MD⁎,
- Emre Ertürk, MD⁎,
- Yusuf Karavelioğlu, MD⁎,
- Tayyar Gökdeniz, MD⁎,
- Hasan Kaya, MD⁎,
- Ozan Mustafa Gürsoy, MD⁎,
- Beytullah Çakal, MD⁎,
- Süleyman Karakoyun, MD⁎,
- Nilüfer Duran, MD⁎ and
- Nihal Özdemir, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Mehmet Özkan, Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Denizer Caddesi, Cevizli-Kartal, Turkey, Istanbul, Istanbul 34846, Turkey
Objectives The aim of this prospective study was to identify the most effective and safest regimen among different thrombolytic treatment strategies.
Background The best treatment strategies for prosthetic valve thrombosis have been controversial.
Methods Transesophageal echocardiography–guided thrombolytic treatment was administered to 182 consecutive patients with prosthetic valve thrombosis in 220 different episodes (156 women; mean age, 43.2 ± 13.06 years) between 1993 and 2009 at a single center. These regimens chronologically included rapid (Group I), slow (Group II) streptokinase, high-dose (100 mg) tissue plasminogen activator (t-PA) (Group III), a half-dose (50 mg) and slow infusion (6 h) of t-PA without bolus (Group IV), and a low dose (25 mg) and slow infusion (6 h) of t-PA without bolus (Group V). The endpoints were thrombolytic success, in-hospital mortality, and nonfatal complication rates.
Results The overall success rate in the whole series was 83.2%; it did not differ significantly among Groups I through V (68.8%, 85.4%, 75%, 81.5%, and 85.5%, respectively; p = 0.46). The overall complication rate in the whole series was 18.6%. Although the overall complication rate was similar among Groups I through IV (37.5%, 24.4 %, 33.3%, and 29.6%, respectively; p > 0.05 for each comparison), it was significantly lower in Group V (10.5%, p < 0.05 for each). The combined rates of mortality and nonfatal major complications were also lower in Group V than in the other groups, with all differences significant except for comparison of Groups IV and V. By multivariate analysis, the predictors of combined mortality plus nonfatal major complications were any thrombolytic therapy regimen other than Group V (odds ratios for Groups I through IV: 8.2, 3.8, 8.1, and 4.1, respectively; p < 0.05 for each) and a history of stroke/transient ischemic attack (odds ratio: 3.5, p = 0.011). In addition, there was no mortality in Group V.
Conclusions Low-dose slow infusion of t-PA repeated as needed without a bolus provides effective and safe thrombolysis in patients with prosthetic valve thrombosis. (Comparison of Different TRansesophageal Echocardiography Guided thrOmbolytic Regimens for prosthetIc vAlve Thrombosis; NCT01451320)
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 6, 2012.
- Revision received October 2, 2012.
- Accepted October 4, 2012.
- American College of Cardiology Foundation