Management of prosthetic valve thrombosis
Management of prosthetic valve thrombosis: If the thrombus in the prosthetic valve is less than 5 mm in size, only intravenous heparin is recommended. For larger thrombi there are two options: thrombolysis versus surgical treatment.
Thrombolysis for prosthetic valve thrombosis
Thrombolysis has an initial success rate of 70 -80%, but there is a 5 -22% risk of embolism, and 5 -12% risk of disabling stroke. Thrombolysis is the preferred treatment for right sided prosthetic valve thrombosis and small left sided thrombi.
Surgical treatment for prosthetic valve thrombosis
Surgical treatment has a combined risk of death or stroke of 9%. In patients presenting with stroke, surgery is the first option as thrombolysis is contraindicated.
It may be noted that there are two types of prosthetic heart valves: mechanical heart valves and bioprosthetic heart valves. While mechanical heart valves are always implanted surgically, bioprosthetic heart valves can be implanted either by surgery or catheter based techniques. Bioprosthetic heart valves are at risk of thrombosis in the initial period after implantation till they get endothelialized. Mechanical prosthetic heart valves have a life long risk of prosthetic valve thrombosis and thromboembolism and hence need life long anti coagulation. Though mechanical prosthetic valves are more thrombogenic, they are also more durable and often lasts several decades with good function.