Thrombolytic Therapy for the Treatment of Prosthetic Heart Valve Thrombosis in Pregnancy with Low Dose, Slow Infusion of t-PA
Background—Prosthetic valve thrombosis (PVT) during pregnancy is life-threatening for mother and fetus, and the treatment of this complication is unclear. Cardiac surgery in pregnancy is associated with very high maternal and fetal mortality and morbidity. Thrombolytic therapy (TT) has been rarely used in these patients. The aim of this study is to evaluate the safety and efficacy of low-dose (25 mg), slow infusion (6 hours) of t-PA (tissue plasminogen activator) for the treatment of PVT in pregnant women.
Methods and Results—Between 2004 and 2012, t-PA was administered to 24 consecutive women in 25 pregnancies with 28 PVT episodes (obstructive n=15; non-obstructive n=13). Mean age of the patients was 29±6 years. TT sessions were performed under transesophageal echocardiography guidance. The mean dose of t-PA used was 48.7±29.5 mg (range 25-100mg). All episodes resulted in complete thrombus lysis following TT. One patient had placental hemorrhage with preterm live birth occurred at 30th week, and one patient had minor bleeding.
Conclusions—Low-dose, slow infusion of t-PA with repeated doses as needed is an effective therapy with excellent thrombolytic success rate for the treatment of PVT in pregnant women. This protocol also seems to be safer than cardiac surgery or any alternative medical strategies published to date. TT should be considered as first-line therapy in pregnant patients with PVT.
- Received January 21, 2013.
- Revision received May 26, 2013.
- Accepted June 4, 2013.