PMID- 26113471
OWN - NLM
STAT- MEDLINE
DCOM- 20160602
LR  - 20161125
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 197
DP  - 2015 Oct 15
TI  - Non-obstructive prosthetic heart valve thrombosis (NOPVT): Really a benign 
      entity?
PG  - 16-22
LID - S0167-5273(15)01322-4 [pii]
LID - 10.1016/j.ijcard.2015.06.021 [doi]
AB  - AIMS: To assess the effectiveness of different treatment strategies in patients 
      with non-obstructive prosthetic valve thrombosis (NOPVT) during hospitalization 
      and long-term follow-up. METHODS: NOPVT was diagnosed by transesophageal 
      echocardiography. Resolution was defined as the disappearance or reduction of the 
      thrombus under anticoagulation. All cases were first managed with optimization of 
      anticoagulation. At discharge, patients received oral anticoagulation (OAC) alone 
      or OAC and antiplatelet therapy (double treatment). Adverse events were defined 
      as cardiovascular death, recurrence, thromboembolic events or major bleeding. 
      RESULTS: From 1997 to 2012, 47 patients (mean age: 65years; women: 60%) were 
      diagnosed with NOPVT (mitral valve: 97%). Previous poor anticoagulation control 
      was documented in 66% of patients. Twenty-one patients (45%) were treated with 
      unfractionated heparin (UFH), especially those with thrombus size >10mm (19/21). 
      Optimization of OAC was performed in the remaining patients. Treatment failed in 
      13 (27.6%) patients, mostly in those who received UFH (10/13), requiring surgery 
      (53.8%) or fibrinolysis (30.7%). Forty-two patients survived and, at discharge, 
      44% of patients received OAC alone and 56% the double treatment. At follow-up 
      (median 23months; range 0.03-116months), 59.5% of patients presented 
      cardiovascular events, however no differences in outcome were observed with 
      double treatment or OAC alone (p=0.385). CONCLUSIONS: NOPVT is a high-risk 
      complication, not only during hospitalization but also during follow-up. 
      Optimization of anticoagulation is efficient in most patients except in thrombi 
      >/=10mm treated with UFH. The double treatment does not prevent adverse events or 
      complications during follow-up.
CI  - Copyright (c) 2015 Elsevier Ireland Ltd. All rights reserved.
FAU - Mutuberria-Urdaniz, Maria
AU  - Mutuberria-Urdaniz M
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain. 
      Electronic address: mariamutuber@gmail.com.
FAU - Rodriguez-Palomares, Jose F
AU  - Rodriguez-Palomares JF
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.
FAU - Ferreira, Ignacio
AU  - Ferreira I
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.
FAU - Baneras, Jordi
AU  - Baneras J
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.
FAU - Teixido, Gisela
AU  - Teixido G
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.
FAU - Gutierrez, Laura
AU  - Gutierrez L
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.
FAU - Zavala, German
AU  - Zavala G
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.
FAU - Gonzalez-Alujas, Maria T
AU  - Gonzalez-Alujas MT
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.
FAU - Evangelista, Artur
AU  - Evangelista A
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.
FAU - Tornos, Pilar
AU  - Tornos P
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.
FAU - Garcia-Dorado, David
AU  - Garcia-Dorado D
AD  - Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain; 
      Institut de Recerca (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain.
LA  - eng
PT  - Journal Article
DEP - 20150618
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Aged
MH  - Anticoagulants/therapeutic use
MH  - Echocardiography, Transesophageal
MH  - Female
MH  - Heart Valve Prosthesis/*adverse effects
MH  - Hemorrhage/etiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Prospective Studies
MH  - Recurrence
MH  - Thromboembolism/etiology
MH  - Thrombosis/diagnostic imaging/*etiology
OTO - NOTNLM
OT  - Anticoagulation
OT  - Cardiovascular event
OT  - Echocardiography
OT  - Embolus
OT  - Prosthetic heart valve
OT  - Thrombosis
EDAT- 2015/06/27 06:00
MHDA- 2016/06/03 06:00
CRDT- 2015/06/27 06:00
PHST- 2014/11/02 00:00 [received]
PHST- 2015/05/03 00:00 [revised]
PHST- 2015/06/16 00:00 [accepted]
PHST- 2015/06/27 06:00 [entrez]
PHST- 2015/06/27 06:00 [pubmed]
PHST- 2016/06/03 06:00 [medline]
AID - S0167-5273(15)01322-4 [pii]
AID - 10.1016/j.ijcard.2015.06.021 [doi]
PST - ppublish
SO  - Int J Cardiol. 2015 Oct 15;197:16-22. doi: 10.1016/j.ijcard.2015.06.021. Epub 
      2015 Jun 18.