Thrombolytic treatment of prosthetic valve thrombosis: a study using Urokinase

ObjectiveWe analysed the efficacy and safety of thrombolytic therapy with urokinase in patients with prosthetic valve thrombosis.MethodsTwenty-three patients with valve thrombosis received thrombolytic treatment using urokinase. First, a 250,000IU intravenous bolus injection was administered as a loading dose, followed by intravenous infusion of 100,000IU/h for 10h and anticoagulation with low molecular weight heparin every day. The maximum treatment time was 5 days, i.e., until the transvalvular pressure gradient was normal or close to normal. Transthoracic echocardiography (TTE) was used every 12h to monitor whether the thrombus was reduced and whether there was haemodynamic improvement. Routine blood tests, the prothrombin time (PT), international normalized ratio (INR) and complications were observed every day.ResultsSixteen (69.6%) patients were successfully treated with thrombolytic therapy: 2/2 (100%) aortic valves and 14/21 (66.7%) mitral valves. The partial success rate of this study was 13.0% (3/23). Four patients did not show any improvement in haemodynamics. Two cases had slight urine haemorrhage. One patient died of severe cerebral haemorrhage and shock. The overall mortality was 13.0% (3/23), including two patients who died after subsequent surgery.ConclusionUrokinase is more convenient and successful in the treatment of PVT. More experience may make TT the optimal treatment for PVT, especially in high-risk surgical situations.