Thrombolysis Bests Surgery In Most Cases Of Obstructive Mechanical Valve Thrombosis

HATTUSHA is a multicenter observational prospective study in which the researchers included 158 obstructive PVT patients who were treated at one of eight tertiary centers between December 2013 and December 2020. They performed TT using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery.

Key findings of the study:

• Among 158 patients, 83 (52.5%) patients had TT and 75 (47.5%) patients undergone surgery.
• Upon analysis, the researchers observed that the success rate of TT was 90.4% with a median t-PA dose of 59 mg.
• They found that the hospital length of stay was longer and rates of minor and major complications, major bleeding, re-thrombosis, and mortality at 3 months (the primary endpoint) were all higher with surgery.

The authors concluded, "Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT."

In an accompanying editorial, Dr Hartzell V. Schaff wrote, "it is unlikely that such studies will guide medical versus surgical therapy of valve thrombosis in the near future," But ultimately these data "establish the effectiveness and relative safety of slow and/or ultraslow tPA infusion, which should be offered to most eligible patients with thrombotic obstruction of mechanical valves," he concludes.

For further information:

DOI: https://www.jacc.org/doi/abs/10.1016/j.jacc.2021.12.027

Keywords:

Obstructive prosthetic valve thrombosis, HATTUSHA Study, mechanical valves, tPA, thrombolytic therapy, tissue plasminogen activator, Low dose of tPA, Slow infusion of tPA, thrombosis, Journal of the American College of Cardiology.