Clinical profile of patients with prosthetic heart valve thrombosis undergoing fibrinolytic therapy and NYHA class as a predictor of outcome

Mehrdad Jafari Fesharaki; Mohammad Parsa Mahjoob; Naser Kachoeian; Vahid Eslami

doi:10.5812/intjcardiovascpract-131480

International Journal of Cardiovascular Practice

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Clinical profile of patients with prosthetic heart valve thrombosis undergoing fibrinolytic therapy and NYHA class as a predictor of outcome

Author(s):

Mehrdad Jafari Fesharaki

^1,*,

Mohammad Parsa Mahjoob²,

Naser Kachoeian³,

Vahid Eslami⁴

1Department of Cardiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2Prevention of Cardiovascular Disease Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3Department of Cardiovascular Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

International Journal of Cardiovascular Practice:Vol. 5, issue 2; e131480

Published online:Oct 30, 2020

Article type:Research Article

Received:Mar 25, 2020

Accepted:Sep 18, 2020

How to Cite:Jafari Fesharaki M, Mahjoob M P, Kachoeian N, Eslami V. Clinical profile of patients with prosthetic heart valve thrombosis undergoing fibrinolytic therapy and NYHA class as a predictor of outcome.Int J Cardiovasc Pract.2020;5(2):e131480.

Abstract

Introduction: Prosthetic heart valve thrombosis (PHVT) is a major complication in patients with mechanical prosthetic heart valve which occurs primarily due to ineffective anticoagulation. This study aimed to evaluate the clinical profile of the patients presenting with PHVT undergoing fibrinolytic therapy and analyzing patients with respect to New York Heart Association (NYHA) functional class on presentation and its association with outcome of fibrinolytic therapy.

Methods: This was prospective, observational study conducted from June, 2016 to April, 2018. Total 133 patients with prosthetic heart valve thrombosis were included. Routine blood investigations included complete hemogram, liver and renal function tests. Prothrombin time with INR was done on admission. The diagnosis of PHVT was assessed by cine-fluoroscopy (CF) and/or echocardiography (transthoracic/transesophageal). Follow-up at 6 months was scheduled for all patients.

Results: All patients received fibrinolytic therapy in which 108 (81.2%) were treated with streptokinase and 25 (18.8%) were treated with urokinase. On presentation, 48.9% patients were in NYHA class III, 41.4% in NYHA class IV and 9.77% in NYHA class II. Fibrinolytic therapy was successful in 105 patients (78.9%) and it failed in 28 patients (21.1%). Mortality in NYHA class II was 0%, NYHA class III was 4.6% and in NYHA class IV was 23.6%. During 6 months follow up prosthetic heart valve thrombosis recurred in 12 (11.43%) patients.

Conclusion: From our single center experience, fibrinolytic therapy is effective first line therapy for prosthetic heart valve thrombosis and NYHA functional class on presentation can predict the outcome of fibrinolytic therapy.

Keywords

NYHA Class

Prosthetic Heart Valve

Thrombosis

Fibrinolytic Therapy

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Author(s):

Mehrdad Jafari Fesharaki:[PubMed][Scholar]
Mohammad Parsa Mahjoob:[PubMed][Scholar]
Naser Kachoeian:[PubMed][Scholar]
Vahid Eslami:[PubMed][Scholar]

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Clinical profile of patients with prosthetic heart valve thrombosis undergoing fibrinolytic therapy and NYHA class as a predictor of outcome

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