Protocol for thrombolysis of prosthetic valve thrombosis

Protocol for thrombolysis of prosthetic valve thrombosis

Protocol for thrombolysis of prosthetic valve thrombosis: Two types of fibrinolytic protocols have been advised for the management of prosthetic valve thrombosis by Raymond Roudaut, Karim Serri and Stephane Lafitte [1]. The short protocol is for rapid thrombolysis in a hemodynamically unstable patient while the long protocol is for a hemodynamically stable patient.

Short protocol for hemodynamically unstable patients

Recombinant tissue plasminogen activator (rtPA) ten milligram bolus followed by ninety milligram in ninety minutes OR streptokinase one and a half million units in sixty minutes without heparin.

Long protocol for hemodynamically stable patients

This protocol is often preferred using either:

Urokinase 4500 units/kg/hour for 12 hours OR 2000 units/kg/hour + heparin for 24 hours

OR streptokinase 500000 units over 20 minutes followed by 1500000 units over 10 hours without heparin

OR rtPA 10 mg bolus, 50 mg during the first hour, 20 mg during the second hour and 20 mg during the third hour.

According to the authors [1], obstructive prosthetic valve thrombosis is better treated with surgery. Thrombolysis is considered for patients with poor functional class – New York Heart Association (NYHA) III or IV and those with high surgical risk or contraindications for surgery. In NYHA class I and II patients, thrombolysis for prosthetic valve thrombosis may also be considered in those with small thrombi if heparin treatment has not succeeded. In any case the risk of systemic thromboembolism during prosthetic valve thrombolysis has to be borne in mind, as well as the potential bleeding risk of thrombolysis.

Reference

  1. Raymond Roudaut, Karim Serri, Stephane Lafitte. Thrombosis of Prosthetic Heart Valves: Diagnosis and Therapeutic Considerations. Heart. 2007 Jan;93(1):137-42.