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Bemurat LR, Laffort PR, Deville CJ, et al. Management of Nonobstructive Thrombosis of Prosthetic Mitral Valve in Asymptomatic Patients in the Early Postoperative Period: A Study in 20 Patients. Echocardiography. 1999;16(4):339-346doi: 10.1111/j.1540-8175.1999.tb00823.x.
Bemurat, L. R., Laffort, P. R., Deville, C. J., Roques, X. G., Baudet, E. M., & Roudaut, R. P. (1999). Management of Nonobstructive Thrombosis of Prosthetic Mitral Valve in Asymptomatic Patients in the Early Postoperative Period: A Study in 20 Patients. Echocardiography (Mount Kisco, N.Y.), 16(4), 339-346. https://doi.org/10.1111/j.1540-8175.1999.tb00823.x
Bemurat, Laurent R., et al. "Management of Nonobstructive Thrombosis of Prosthetic Mitral Valve in Asymptomatic Patients in the Early Postoperative Period: A Study in 20 Patients." Echocardiography (Mount Kisco, N.Y.) vol. 16,4 (1999): 339-346. doi: https://doi.org/10.1111/j.1540-8175.1999.tb00823.x
Bemurat LR, Laffort PR, Deville CJ, Roques XG, Baudet EM, Roudaut RP. Management of Nonobstructive Thrombosis of Prosthetic Mitral Valve in Asymptomatic Patients in the Early Postoperative Period: A Study in 20 Patients. Echocardiography. 1999 May;16(4):339-346. doi: 10.1111/j.1540-8175.1999.tb00823.x. PMID: 11175159.
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Echocardiography. 1999 May;16(4):339-346. doi: 10.1111/j.1540-8175.1999.tb00823.x.

Management of Nonobstructive Thrombosis of Prosthetic Mitral Valve in Asymptomatic Patients in the Early Postoperative Period: A Study in 20 Patients.

Echocardiography (Mount Kisco, N.Y.)

Laurent R. Bemurat, Patrick R. Laffort, Claude J. Deville, Xavier G. Roques, Eugene M. Baudet, Raymond P. Roudaut

Affiliations

  1. 20, rue Beausoleil, Gradignan 33170, France.

PMID: 11175159 DOI: 10.1111/j.1540-8175.1999.tb00823.x

Abstract

The purpose of the present study was to determine the optimal management of nonobstructive thrombi in the early postoperative period after mitral valve replacement.Twenty cases of early thrombi were revealed by systematic transesophageal echocardiography (TEE) performed 9 days after surgical implantation of 229 St. Jude prostheses. Patients were prospectively randomized into two groups: the first group received oral anticoagulants (fluindione), and the second group was treated with a combination of oral anticoagulants and aspirin. The impact of the different therapies on prosthetic thrombi was assessed by systematic TEE at 5 months. All thrombi were nonobstructive and disappeared without fibrinolytic agents or surgery. Seven large (>/= 5 mm) thrombi disappeared: in two patients after reintroduction of intravenous heparin and in five patients with an optimized oral treatment (anticoagulants alone in one patient, anticoagulants associated with aspirin in four patients). In the 13 small (< 5 mm) thrombi, 11 disappeared with an optimized oral treatment: anticoagulants alone in nine patients and anticoagulants associated with aspirin in two patients. The other two small thrombi treated with heparin alone initially persisted and finally disappeared with heparin associated with aspirin. In the group with large thrombi, we recorded a 43% rate of thromboembolic events, with more deaths and severe cerebral embolic events than in the patients with small thrombi. Embolic events were associated with mobile thrombi. An optimized oral anticoagulation therapy with correction of the parameters of Virchow et al. is effective in the treatment of small prosthetic thrombi. For large thrombi, the high rate of thromboembolic events would appear to require a more aggressive approach such as an association of heparin with aspirin and TEE follow-up.

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