Abstract 4697: Comparing Different Intravenous Thrombolytic Treatment Regimens in Patients with Prosthetic Heart Valve Thrombosis Under the Guidance of Serial Transesophageal Echocardiography: A 15-Year Study in a Single Center (TROIA Trial)
Optimal treatment and concerns for complications (Cs) of prosthetic heart valve thrombosis (PHVT) remains unsolved. We aimed to evaluate the outcomes of different thrombolytic therapy (TT) protocols, under the guidance of serial transesophageal echocardiography (TEE). A total of 133 pts (82 F, mean age 52 years) with PHVT underwent 268 TT sessions for 163 distinct episodes between 1993 and 2008. Thrombosis comprised 138 mitral, 15 aortic and 10 tricuspid PHVT episodes. All pts underwent TT under the guidance of serial TEE. Successive infusions were used if the desired effect was not achieved. Major Cs included, embolic Cs resulting in irreversible neurologic damage, or myocardial infarction, or needing limb-salvage surgery or bleedings necessitated blood transfusion. Pts in Group A (n=48 episodes) received 1.5 million units of streptokinase (SKZ) over 15–24 h in the first 7 years of the study. Group B (n=11) consisted of pts treated with 100 mg tissue type plasminogen activator (tPA). In pts unresponsive to tPA (Group C, n=8), 100 mg tPA was combined with SKZ between 2000 and 2002. Pts in Group D (n=25) treated with 50 mg tPA between 2003 to 2005, and pts in Group E (n=71) were treated with 25 mg tPA without bolus administration over 6 h in single or successive doses since 2005. Overall success with one or more consecutive TT was obtained in 137 episodes (84%): 13/15 (86.7%) for aortic valve, 115/138 (83.3%) mitral valve, and 9/10 tricuspid prostheses (90%) (p>0.05). Overall success rate and minor Cs were similar between Groups A to E (p>0.05). Major Cs were significantly lower in Group D and E (p<0.05). Furthermore, there were no major Cs or death in Group E (Table⇓). Although overall success rates were equivalent in all groups, low dose (25 mg), and slow (6 h) infusion of tPA without bolus is clearly superior to other regimens in terms of morbidity and mortality, promising new era for TT.