PMID- 31409533
OWN - NLM
STAT- MEDLINE
DCOM- 20201126
LR  - 20201126
IS  - 1444-2892 (Electronic)
IS  - 1443-9506 (Linking)
VI  - 29
IP  - 3
DP  - 2020 Mar
TI  - Management and Outcomes of Prosthetic Valve Thrombosis. An Australian Case Series 
      From the Northern Territory.
PG  - 469-474
LID - S1443-9506(19)31366-6 [pii]
LID - 10.1016/j.hlc.2019.07.005 [doi]
AB  - BACKGROUND: Prosthetic valve thrombosis (PVT) is an uncommon but serious cause of 
      morbidity and mortality after cardiac valve implantation. The most common cause 
      leading to PVT is inadequate anticoagulation. Royal Darwin Hospital is a major 
      referral centre for the Top End of Australia and is unique in having a high 
      burden of rheumatic heart disease (RHD) requiring valve surgery, issues with 
      adherence with oral anticoagulants, and the absence of onsite cardiothoracic 
      facility. METHODS: We report clinical characteristics and outcomes of consecutive 
      patients presenting with PVT to a single centre without on-site cardiothoracic 
      surgery. RESULTS: Thirty-two (32) episodes involving 21 patients were 
      retrospectively identified between 2000 and 2017. Our cohort had an average age 
      of 37 years. Nineteen (19) patients were of Aboriginal or Torres Strait Islander 
      descent. All valves were mechanical, except for one bioprosthetic mitral valve, 
      with average time from implantation to initial PVT 5.1 years. The majority of 
      patients were in New York Heart Association (NYHA) class III and IV (6%, and 66%, 
      respectively). Anti-coagulation was sub-therapeutic in 88% of presentations. 
      Eleven (11) (34%) presentations were recurrent PVT involving eight patients. 
      Twenty-six (26) (82%) episodes were treated with thrombolytic therapy which 
      achieved complete success in 65% and partial success in 19%. Five (5) patients 
      received a second dose of the lytic agent. Of the four patients not responding to 
      thrombolytic therapy, two died and two were urgently transferred to a facility 
      with on-site cardiothoracic surgery. Five (5) out of 32 episodes resulted in 
      death (16%) with overall mortality 24% for the cohort over the entire time 
      period. Thrombolytic therapy was associated with five major bleeding episodes 
      (16%) including two fatal bleeds. CONCLUSIONS: Prosthetic valve thrombosis is a 
      rare but life-threatening complication of prosthetic valves, with the vast 
      majority of patients found to be inadequately anticoagulated. Despite differences 
      in thrombolytic agents these were successful in the majority of patients.
CI  - Crown Copyright (c) 2019. Published by Elsevier B.V. All rights reserved.
FAU - Milne, Owen
AU  - Milne O
AD  - Royal Darwin Hospital, Intensive Care Unit and Department of Cardiology, Darwin, 
      NT, Australia.
FAU - Barthwal, Rohit
AU  - Barthwal R
AD  - Royal Darwin Hospital, Intensive Care Unit and Department of Cardiology, Darwin, 
      NT, Australia. Electronic address: rohit.barthwal@ths.tas.gov.au.
FAU - Agahari, Ian
AU  - Agahari I
AD  - Royal Darwin Hospital, Intensive Care Unit and Department of Cardiology, Darwin, 
      NT, Australia.
FAU - Ilton, Marcus
AU  - Ilton M
AD  - Royal Darwin Hospital, Intensive Care Unit and Department of Cardiology, Darwin, 
      NT, Australia.
FAU - Kangaharan, Nadarajah
AU  - Kangaharan N
AD  - Royal Darwin Hospital, Intensive Care Unit and Department of Cardiology, Darwin, 
      NT, Australia.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20190802
PL  - Australia
TA  - Heart Lung Circ
JT  - Heart, lung & circulation
JID - 100963739
RN  - 0 (Anticoagulants)
SB  - IM
CIN - Heart Lung Circ. 2020 May;29(5):e47-e48. PMID: 31892472
MH  - Administration, Oral
MH  - Adult
MH  - Anticoagulants/*administration & dosage
MH  - Disease-Free Survival
MH  - Female
MH  - Heart Valve Prosthesis/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Northern Territory
MH  - Retrospective Studies
MH  - *Rheumatic Heart Disease/mortality/therapy
MH  - Survival Rate
MH  - *Thrombolytic Therapy
MH  - *Thrombosis/etiology/mortality/therapy
OTO - NOTNLM
OT  - Cardiology
OT  - Prosthetic valve thrombosis
OT  - Rheumatic heart disease
OT  - Thrombolysis
EDAT- 2019/08/15 06:00
MHDA- 2020/11/27 06:00
CRDT- 2019/08/15 06:00
PHST- 2019/02/28 00:00 [received]
PHST- 2019/05/13 00:00 [revised]
PHST- 2019/07/16 00:00 [accepted]
PHST- 2019/08/15 06:00 [pubmed]
PHST- 2020/11/27 06:00 [medline]
PHST- 2019/08/15 06:00 [entrez]
AID - S1443-9506(19)31366-6 [pii]
AID - 10.1016/j.hlc.2019.07.005 [doi]
PST - ppublish
SO  - Heart Lung Circ. 2020 Mar;29(3):469-474. doi: 10.1016/j.hlc.2019.07.005. Epub 
      2019 Aug 2.