Abstract 16214: Survivors of Prosthetic Valve Thrombosis: Predictors of Long-Term Outcome and Role of Medical Treatment at Discharge
Purpose: To assess the rate and predictors of adverse events during long-term follow-up of survivors of prosthetic valve thrombosis (PVT) and the role of the treatment at discharge: oral anticoagulation (OAC) vs. dual therapy (DT: anticoagulation + antiplatelets).
Methods: According to guidelines, surgery was the treatment of choice in obstructive thrombosis and inoperable patients were treated with fibrinolysis or anticoagulation. All non-obstructives were first treated with anticoagulation. At discharge, survivors received OAC or DT. We recorded cardiovascular death, recurrence, thromboembolic events or major bleeding during follow up.
Results: From 1984 to 2013, 158 PVT were diagnosed, 108 obstructive, 50 non-obstructive (women 61%, mitral valve 83%). During hospitalization, surgery was performed in 64 patients (41%), fibrinolysis in 33 (21%) and optimization of anticoagulation in 61 (38%). The overall mortality was of 23% (26% with surgery, 27% with fibrinolysis and 15% with anticoagulation).
At discharge, survivors received DT in 68 cases: 83% of the fibrinolyzed patients (19/23), 65% of the anticoagulated (33/51) and 34% of the operated (16/47), (p < 0.001), or OAC alone in 53 cases: 17% of the fibrinolyzed (4/23), 35% of the anticoagulated (18/51) and 66% of the operated (31/47), (p < 0.001).
At the end of the follow-up (median: 43 months; range 0-315 m), treatment with DT or OAC did not involve differences in rates of mortality (47.5% vs. 38.5% respectively, p=0.55), thromboembolisms (11.8% vs. 7.5% respectively, p=0.44), and major bleeding (11.8% vs. 15.1% respectively, p=0.59). However, recurrence of PVT was higher in the ones treated with DT (25.0% vs. 9.4%, p=0.03). In the multivariate analysis, ejection fraction (OR: 1.12; p=0.008) and the in-hospital treatment (fibrinolysis and anticoagulation vs. surgery; OR 11.03; p=0.023) where the only predictors of PVT recurrences.
Conclusions: PVT supposes a high morbidity and mortality, not only during hospitalization but also at follow-up. Lower ejection fraction and medical treatment during admission (fibrinolysis or anticoagulation) are the main determinants for recurrence. DT after discharge does not provide any benefit compared to OAC regarding mortality, recurrence or bleeding.
- © 2013 by American Heart Association, Inc.