Thrombolytics first-line for valve thrombosis Thrombolytics should be fIrst-line treatment for thrombosis of St Jude prosthetic heart valves, conclude Dr H Silber and colleagues from the Cedars-Sinai Medical Center, Los Angeles, US I . THERAPY Although the incidence of thrombosis of prosthetic valves is very low (probably < 1% annually), it is usually treated by urgent valve re-replacement which is associated with a perioperative mortality rate of about 5-20%. From a series of patients treated by Dr Silber and colleagues over a 13-year period, it would seem that thrombolysis may be a safer, and satisfactorily effective, approach for this type of thrombosis. The outcome of 9/12 initial events of thrombosis of St Jude valves treated with streptokinase, urokinase or heparin was considered successful, as indicated by resumption of > 90% of the nonnal range of valve leaflet motion. Treatment was partially successful in an additional patient. Although 2 patients showed no response to thrombolysis, they were stabilised with conservative therapy and no patients required surgery. During a mean of about 17 months' follow-up, 2 patients experienced recurrent thrombosis (in I patient, this occurred 3 times) which was successfully treated with urokinase. Four patients developed haemorrhagic complications but no patients died as a result of therapy. At present, thrombolytic agents are not approved for use in thrombosis of prosthetic heart valves 2 • However, this report and numerous other case reports suggest that they are becoming an accepted therapy. Although desirable, it will be difficult to conduct comparative studies of treatments as this type of thrombosis is so rare. 1. Silber H. et aI. The Sl. Jude valve. Thrombolysis as the first line of therapy for cardiac valve thrombosis. Circulation 87: 30-37. Jan 19932. McKay CR. Prosthetic heart valve thrombosis. 'What can be done with regard 10 treatment?'. Circulation 87: 294-296. Jan 1993 I!OOI 82 101 ISSN 0156-270319310313-00131$1 .00c AdIs Int.".tlolIlII Ltd 13

Thrombolytics first-line for valve thrombosis

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Thrombolytics first-line for valve thrombosis

Thrombolytics should be fIrst-line treatment for thrombosis of St Jude prosthetic heart valves, conclude Dr H Silber and colleagues from the Cedars-Sinai Medical Center, Los Angeles, US I

THERAPY

Although the incidence of thrombosis of prosthetic valves is very low (probably < 1% annually), it is usually treated by urgent valve re-replacement which is associated with a perioperative mortality rate of about 5-20%. From a series of patients treated by Dr Silber and colleagues over a 13-year period, it would seem that thrombolysis may be a safer, and satisfactorily effective, approach for this type of thrombosis.

The outcome of 9/12 initial events of thrombosis of St Jude valves treated with streptokinase, urokinase or heparin was considered successful, as indicated by resumption of > 90% of the nonnal range of valve leaflet motion. Treatment was partially successful in an additional patient. Although 2 patients showed no response to thrombolysis, they were stabilised with conservative therapy and no patients required surgery.

During a mean of about 17 months' follow-up, 2 patients experienced recurrent thrombosis (in I patient, this occurred 3 times) which was successfully treated with urokinase.

Four patients developed haemorrhagic complications but no patients died as a result of therapy.

At present, thrombolytic agents are not approved for use in thrombosis of prosthetic heart valves2•

However, this report and numerous other case reports suggest that they are becoming an accepted therapy. Although desirable, it will be difficult to conduct comparative studies of treatments as this type of thrombosis is so rare. 1. Silber H. et aI. The Sl. Jude valve. Thrombolysis as the first line of therapy for cardiac valve thrombosis. Circulation 87: 30-37. Jan 19932. McKay CR. Prosthetic heart valve thrombosis. 'What can be done with regard 10 treatment?' . Circulation 87: 294-296. Jan 1993 I!OOI 82 101

ISSN 0156-270319310313-00131$1 .00c AdIs Int.".tlolIlII Ltd