Key result
Urgent surgery was not superior to fibrinolytic therapy at restoring valve function (OR 2.53; 95% CI 0.94-6.78; P=0.066), but significantly reduced thrombo-embolism, major bleeding, and recurrent PVT.
Why the study?
Does urgent surgery improve complete restoration of valve function and reduce complications in patients with left-sided prosthetic valve thrombosis compared to fibrinolytic therapy?
Population
690 episodes of left-sided prosthetic valve thrombosis (PVT) pooled from 7 observational studies
Comparison
Urgent surgery vs Fibrinolytic therapy (FT)
Design
Meta-analysis
Authors
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May favor urgent surgery to reduce complications in left-sided PVT; leaves open need for RCTs on valve function restoration.
Meta-Analysis (n=690)
Does urgent surgery improve complete restoration of valve function and reduce complications in patients with left-sided prosthetic valve thrombosis compared to fibrinolytic therapy?
Odds Ratio: 2.53 (95% CI 0.94–6.78)
Absolute Event Rate: 86.5% vs 69.7%
p-value: p=0.066
Urgent surgery for left-sided prosthetic valve thrombosis significantly reduces thrombo-embolic events, major bleeding, and recurrence compared to fibrinolytic therapy, despite similar rates of valve function restoration.
Karthikeyan et al. (2013) conducted a meta-analysis in Left-sided prosthetic valve thrombosis (n=690). Urgent surgery vs. Fibrinolytic therapy was evaluated on Complete restoration of valve function (OR 2.53, 95% CI 0.94-6.78, p=0.066). Urgent surgery was not superior to fibrinolytic therapy at restoring valve function (OR 2.53; 95% CI 0.94-6.78; P=0.066), but significantly reduced thrombo-embolism, major bleeding, and recurrent PVT.