Sharif Khan Hamid, Ijaz Zainab, Ali Muhammad, Saif Mohsin, Ishaq Uzma, Kamal Ahmed, Ikram Umar, Abdul Sattar Rana, Malik Jahanzeb
Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, PAK.
Internal Medicine, Windsor University School of Medicine, Cayon, KNA.
Cureus. 2020 Jun 22;12(6):e8760. doi: 10.7759/cureus.8760.
Objective To evaluate characteristics and outcomes of patients presenting with mechanical prosthetic valve thrombosis in a tertiary cardiac center in Pakistan. Methods This was a prospective and interventional study conducted at Rawalpindi Institute of Cardiology over a period of two years. The clinical characteristics of patients presenting with clinical suspicion of prosthetic valve thrombosis were recorded. They were, then, subjected to streptokinase, redo surgery and heparin based on their hemodynamic stability, thrombus burden and surgical risk. The patients were then followed for the outcomes of the study. Results Out of 576 patients with mechanical valve replacement during the study period, 70 patients had developed prosthetic valve thrombosis. Out of 70 patients, there were 41 female (58.50%) and 29 male (41.50%) participants. The mean age of the participants was 48.40±15.00 years. The overall incidence of mechanical prosthetic valve thrombosis was 12.15%. There were 30 patients (42.80%) with a suboptimal international normalized ratio (INR) and 28 patients (40.00%) were non-compliant to warfarin therapy. The overall incidence of adverse clinical outcome was 18.00%, while the overall mortality rate was 10.00%. The mortality was higher for patients who underwent redo surgery (16.60%) as compared to patients who had received fibrinolytic therapy (9.60%). Conclusion Poor compliance with warfarin and suboptimal INR are the important factors causing mechanical prosthetic valve. Because of lower mortality rate, fibrinolysis with streptokinase is a reasonable treatment option for mechanical prosthetic valve thrombosis.
目的 评估巴基斯坦一家三级心脏中心机械人工瓣膜血栓形成患者的特征及治疗结果。方法 这是一项在拉瓦尔品第心脏病学研究所进行的为期两年的前瞻性干预研究。记录临床怀疑人工瓣膜血栓形成患者的临床特征。然后，根据他们的血流动力学稳定性、血栓负荷和手术风险，对他们进行链激酶治疗、再次手术和肝素治疗。随后对患者进行随访以观察研究结果。结果 在研究期间接受机械瓣膜置换的576例患者中，70例发生了人工瓣膜血栓形成。在这70例患者中，有41名女性（58.50%）和29名男性（41.50%）。参与者的平均年龄为48.40±15.00岁。机械人工瓣膜血栓形成的总体发生率为12.15%。国际标准化比值（INR）不理想的患者有30例（42.80%），28例（40.00%）患者未遵医嘱接受华法林治疗。不良临床结局的总体发生率为18.00%，而总死亡率为10.00%。与接受纤维蛋白溶解疗法的患者（9.60%）相比，接受再次手术的患者死亡率更高（16.60%）。结论 华法林依从性差和INR不理想是导致机械人工瓣膜血栓形成的重要因素。由于死亡率较低，链激酶纤维蛋白溶解疗法是治疗机械人工瓣膜血栓形成的合理选择。
