Thrombosis of prosthetic heart valve: modern approach to the treatment

D.V. Shatov, E.A. Zakharyan

Abstract


Thrombosis of the heart valve prosthesis is any thrombosis that develops inside or near an implanted prosthesis and affects its normal functioning. Previously, the main me­thod of the treatment consisted in repeated surgical intervention, which has several advantages over the pharmacotherapy: better hemodynamic result, low incidence of thromboembolic events and large bleedings, and also the lower incidence of recurrent thrombosis. However, due to modern diagnostic me­thods, the development of pharmacology, the limited availability of urgent cardiosurgical care to the population, the urgency of drug treatment for thrombotic dysfunction of the valve prosthesis increases. Pharmacotherapy includes systemic thrombolysis and supportive therapy (unfractionated heparin, vitamin K antagonists, acetylsalicylic acid). To provide systemic thrombolysis, recombinant human tissue activator plasminogen (alteplase), fibrinolytic enzymes (streptokinase), genetically modified recombinant plasminogen activator (tenecteplase) are recommended. In a case of partial or complete failure of conservative therapy, the next step is timely surgical treatment, which includes replacing of the affected valve or removal of the thrombotic masses with retention of the original prosthesis. The implementation of thrombolytic therapy does not exclude the option of performing the operative intervention. In a case of partial effectiveness of the drug therapy, the patient undergoes an operative intervention with better hemodynamics and lesser risk. Transcutaneous intervention on the valve prosthesis can also serve as an alternative in patients with ineffective systemic thrombolysis, when open surgery is not possible.

Keywords


thrombosis; prosthetic heart valve; thrombolysis; anticoagulant therapy; review

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DOI: https://doi.org/10.22141/2224-0586.6.85.2017.111602

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