Prolonged Infusions of Low-Dose Thrombolytics in Elderly Patients with Prosthetic Heart Valve Thrombosis

Sabahattin Gündüz, Mehmet Özkan, Mahmut Yesin, Macit Kalçlk, Mustafa Ozan Gürsoy, Süleyman Karakoyun, Mehmet Ali Astarcloǧlu, Ahmet Çaǧrl Aykan, Tayyar Gökdeniz, Murat Biteker, Nilüfer Ekşi Duran, Mustafa Ylldlz

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Background: The outcomes of thrombolytic therapy (TT) in elderly patients with prosthetic valve thrombosis (PVT) have not been evaluated previously. We investigated the outcomes of low-dose and slow infusion TT strategies in elderly patients with PVT. Methods: Twenty-seven (19 female) patients aged ≥65 years (median: 70 years, range: 65-82 years) were treated with repeated TT agents for PVT. The TT regimens included 24-hour infusion of 1.5 million units of streptokinase in 2 patients, 6-hour infusion of 25 mg recombinant tissue plasminogen activator (t-PA) in 12 patients, and 25-hour infusion of 25 mg t-PA in 13 patients. Treatment success and adverse event rates were assessed. Results: The initial and cumulative success rates were 40.7% and 85.2%, respectively. Adverse events occurred in 6 (22.2%) patients including 4 (14.8%) major (1 death, 1 rethrombosis, and 2 failed TT) and 2 (7.4%) minor (1 transient ischemic attack and 1 access site hematoma) events. Higher thrombus burden (thrombus area ≥1.1 cm2 by receiver operating characteristics analysis, sensitivity: 83.3%, specificity: 85%, area under the curve: 0.86, P =.008) and New York Heart Association class (0% vs 15.4% vs 25% vs 100% for classes I-IV, respectively, P =.02) predicted adverse events. By multiple variable analysis, thrombus area was the only independent predictor of adverse events (odds ratio: 13.8, 95% confidence interval: 1.02-185, P =.04). Conclusion: Slow infusion of low doses of TT agents (mostly t-PA) with repetition is successful and safe in elderly patients with PVT. However, excessive thrombus burden may predict adverse events.

Original languageEnglish
Pages (from-to)241-247
Number of pages7
JournalClinical and Applied Thrombosis/Hemostasis
Volume23
Issue number3
DOIs
Publication statusPublished - 1 Apr 2017
Externally publishedYes

Keywords

  • cardiology
  • thrombolytics
  • thrombosis

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