Key result
Fibrinolytic therapy compared to surgery for prosthetic valve thrombosis showed no significant difference in mortality (RR 0.78; 95% CI 0.38-1.60) but higher risks of thromboembolism and bleeding.
Why the study?
The optimal treatment choice between surgery and fibrinolytic therapy for prosthetic valve thrombosis remains debated, with past studies showing conflicting tradeoffs between mortality and complication rates.
Does surgery reduce mortality and complications compared to fibrinolytic therapy in patients with prosthetic valve thrombosis?
Meta-Analysis (n=1,235)
Does surgery reduce mortality and complications compared to fibrinolytic therapy in patients with prosthetic valve thrombosis?
Relative Risk: 0.78 (95% CI 0.38–1.6)
Surgery may be a safer treatment option with fewer complications than fibrinolytic therapy for prosthetic valve thrombosis, though mortality rates are similar.
Surgery may be safer with fewer complications than fibrinolytic therapy for PVT; randomized trials are needed to confirm.
BACKGROUND: Prosthetic valve thrombosis (PVT) is a rare but life-threatening complication. Surgery and fibrinolytic therapy (FT) are the two main treatment options for PVT. The choice between surgery and FT has always been a matter of debate. Previous studies have shown that although the mortality rate is higher in surgery, complications are less frequent than in FT. We aimed to perform a systematic review and meta-analysis to compare the results of surgery and FT in PVT. METHODS: A systematic review of the literature was performed through Medline, Embase, Scopus, and Web of Science, encompassing all studies comparing surgery and FT in PVT. The rate of each complication and risk ratio (RR) of complications in surgery and FT were assessed using random-effects models. RESULTS: Fifteen studies with 1235 patients were included in the meta-analysis. The pooled risk of the mortality was not significantly different between FT and surgery in patients with PVT (pooled RR = 0.78, 95% confidence interval [CI]: 0.38-1.60, I² = 61.4%). The pooled risks of thromboembolic events (pooled RR = 4.70, 95% CI: 1.83-12.07, I² = 49.6%) and major bleeding (pooled RR = 2.45, 95% CI: 1.09-5.50, I² = 41.1%) and PVT recurrence (pooled RR = 2.06 95% CI: 1.29-3.27, I² = 0.0%) were significantly higher in patients who received FT. CONCLUSION: Surgery may be safer and with fewer complications than FT for PVT treatment. However, randomized clinical trials are needed to determine the proper treatment for PVT.
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Sadeghi et al. (2022) conducted a meta-analysis in Prosthetic valve thrombosis (n=1,235). Fibrinolytic therapy vs. Surgery was evaluated on Mortality (RR 0.78, 95% CI 0.38-1.60). Fibrinolytic therapy compared to surgery for prosthetic valve thrombosis showed no significant difference in mortality (RR 0.78; 95% CI 0.38-1.60) but higher risks of thromboembolism and bleeding.
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