Kathirvel D, Justin Paul Gnanaraj, Prathap Kumar Gorijavaram, Palanisamy G, Gnanavelu Ganesan, Ravishankar G, Swaminathan N, Venkatesan Sangareddi
Postgraduate in cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India.
Professor of Cardiology, Institute of Cardiology, Madras Medical College - Rajiv Gandhi Govt General Hospital, Poonamalliee High road, Chennai - 3, India.
Indian Heart J. 2018 Jul-Aug;70(4):506-510. doi: 10.1016/j.ihj.2017.10.014. Epub 2017 Nov 14.
Prosthetic valve thrombosis (PVT) is a dreadful complication of mechanical prosthetic valves. Thrombolytic therapy (TT) for PVT is an alternative to surgery and currently making a leading role. This study compares TT with tenecteplase (TNK) and streptokinase (SK) head to head in patients with mitral PVT.
In this single center, observational study, patients with mitral PVT diagnosed by clinical data, transthoracic echocardiography, transesophageal echocardiography, and fluoroscopy were included. After excluding patients with contraindications for thrombolysis, they were randomly assigned to receive either SK or TNK regimen. Patients were monitored for success or failure of TT and for any complications.
Among 52 episodes (47 patients with 5 recurrences) of mechanical mitral PVT, 40 patients were thrombolyzed with SK and 12 patients were thrombolyzed with TNK. Baseline characteristics including demographic profile, clinical and echocardiographic features, and valve types were not statistically significant between the groups. Complete success rate was 77.5% in SK group and 75% in TNK group (p=0.88). Partial success rate, failure rate, and major complications were not statistically significant between the two groups. Within 12h of therapy, TNK showed complete success in 33.3% of patients compared to 15% in SK group (p-value <0.02). Minor bleeding was more common in TNK group.
Slow infusion of TNK is equally efficacious but more effective than SK in the management of mitral mechanical PVT. 75% to 77.5% of PVT patients completely recovered from TT and it should be the first line therapy where the immediate surgical options were remote.
人工瓣膜血栓形成（PVT）是机械人工瓣膜的一种可怕并发症。PVT的溶栓治疗（TT）是手术的一种替代方法，目前正发挥着主导作用。本研究对二尖瓣PVT患者使用替奈普酶（TNK）和链激酶（SK）进行TT的疗效进行了直接比较。
在这项单中心观察性研究中，纳入了通过临床数据、经胸超声心动图、经食管超声心动图和荧光透视诊断为二尖瓣PVT的患者。在排除有溶栓禁忌证的患者后，将他们随机分配接受SK或TNK治疗方案。对患者进行TT成功或失败以及任何并发症的监测。
在52例机械性二尖瓣PVT发作（47例患者，5例复发）中，40例患者接受了SK溶栓治疗，12例患者接受了TNK溶栓治疗。两组之间的基线特征包括人口统计学资料、临床和超声心动图特征以及瓣膜类型无统计学差异。SK组的完全成功率为77.5%，TNK组为75%（p = 0.88）。两组之间的部分成功率、失败率和主要并发症无统计学差异。在治疗后12小时内，TNK组33.3%的患者取得了完全成功，而SK组为15%（p值<0.02）。TNK组轻微出血更为常见。
在二尖瓣机械性PVT的治疗中，缓慢输注TNK同样有效，但比SK更有效。75%至77.5%的PVT患者通过TT完全康复，在没有立即手术选择的情况下，TT应作为一线治疗方法。
