{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:04:35Z","timestamp":1780099475971,"version":"3.54.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"3_suppl","license":[{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,10,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background:<\/jats:title>\n                  <jats:p>A significant number of patients with prosthetic valve thrombosis have a prothrombin time international normalised ratio in the therapeutic range at presentation. Surgery may not be possible in many patients and traditionally a high international normalised ratio is considered a relative contraindication for fibrinolysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods:<\/jats:title>\n                  <jats:p>We conducted an observational study in patients with left-sided obstructive prosthetic valve thrombosis with international normalised ratio at or above the therapeutic range at presentation who received fibrinolysis. The fibrinolytic regimens, timing of initiation, success of fibrinolysis, risk of major and minor bleeding and ischaemic stroke were evaluated in the study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results:<\/jats:title>\n                  <jats:p>Of 30 patients included in the study 70% received immediate fibrinolysis and in 30% it was delayed. The majority of patients (90%) presented with New York Heart Association class III\/IV symptoms. The mean international normalised ratio at fibrinolysis was 3.04 \u00b1 0.70 in the immediate group and 2.42 \u00b1 0.89 in the delayed group. Haemodynamically stable patients who had delayed initiation of fibrinolysis had a trend towards less bleeding without an increase in mortality. The rates of intracranial haemorrhage (0% vs. 7.7%), minor bleeding (12.5% vs. 25.1%) and ischaemic stroke (0% vs. 30.7%) were lower in patients who received low dose infusion compared to a conventional dose.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions:<\/jats:title>\n                  <jats:p>Fibrinolysis can be considered in patients with prosthetic valve thrombosis with high international normalised ratio at presentation. For haemodynamically stable patients, delayed initiation of fibrinolysis is associated with a marginally lower bleeding risk without an increase in mortality. Low dose infusion may be considered over a conventional dose as it is associated with a lower incidence of ischaemic stroke and a good rate of valve function restoration with a trend towards less bleeding.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1177\/2048872619846329","type":"journal-article","created":{"date-parts":[[2019,4,26]],"date-time":"2019-04-26T15:39:10Z","timestamp":1556293150000},"page":"S58-S62","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Fibrinolysis in left-sided mechanical prosthetic valve thrombosis with high INR"],"prefix":"10.1093","volume":"9","author":[{"given":"KR","family":"Nishanth","sequence":"first","affiliation":[{"name":"Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mythri","family":"Shankar","sequence":"additional","affiliation":[{"name":"Institute of Nephro Urology, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KH","family":"Srinivasa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CN","family":"Manjunath","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KS","family":"Ravindranath","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,1]]},"reference":[{"key":"2021020117053005000_bibr1-2048872619846329","first-page":"225","article-title":"Anticoagulation protocol and early prosthetic valve thrombosis","volume":"56","author":"Talwar","year":"2004","journal-title":"Indian Heart J"},{"key":"2021020117053005000_bibr2-2048872619846329","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1136\/hrt.2005.071183","article-title":"Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations","volume":"93","author":"Roudaut","year":"2007","journal-title":"Heart"},{"key":"2021020117053005000_bibr3-2048872619846329","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1093\/eurheartj\/ehx391","article-title":"2017 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"38","author":"Baumgartner","year":"2017","journal-title":"Eur Heart J"},{"key":"2021020117053005000_bibr4-2048872619846329","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1161\/CIR.0000000000000029","article-title":"2014 AHA\/ACC Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"129","author":"Nishimura","year":"2014","journal-title":"Circulation"},{"key":"2021020117053005000_bibr5-2048872619846329","first-page":"567","article-title":"Recommendations for the management of prosthetic valve thrombosis","volume":"14","author":"Lengyel","year":"2005","journal-title":"J Heart Valve Dis"},{"key":"2021020117053005000_bibr6-2048872619846329","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1093\/eurheartj\/ehs486","article-title":"Urgent surgery compared with fibrinolytic therapy for the treatment of left-sided prosthetic heart valve thrombosis: a systematic review and meta-analysis of observational studies","volume":"34","author":"Karthikeyan","year":"2013","journal-title":"Eur Heart J"},{"key":"2021020117053005000_bibr7-2048872619846329","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1111\/jth.12577","article-title":"Thrombolytic therapy or surgery for valve prosthesis thrombosis: systematic review and meta-analysis","volume":"12","author":"Castilho","year":"2014","journal-title":"Thromb Haemost"},{"key":"2021020117053005000_bibr8-2048872619846329","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1016\/j.jacc.2013.07.075","article-title":"Treatment of obstructive thrombosed prosthetic heart valve","volume":"62","author":"Huang","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2021020117053005000_bibr9-2048872619846329","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur Heart J"},{"key":"2021020117053005000_bibr10-2048872619846329","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1161\/STR.0b013e318284056a","article-title":"Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"44","author":"Jauch","year":"2013","journal-title":"Stroke"},{"key":"2021020117053005000_bibr11-2048872619846329","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1136\/hrt.2005.062158","article-title":"Is warfarin a contraindication to thrombolysis in acute ST elevation myocardial infarction?","volume":"92","author":"Stanley","year":"2006","journal-title":"Heart"},{"key":"2021020117053005000_bibr12-2048872619846329","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1111\/j.1468-1331.2011.03455.x","article-title":"Hemorrhagic complications after systemic thrombolysis in acute stroke patients with abnormal baseline coagulation","volume":"18","author":"Brunner","year":"2011","journal-title":"Eur J Neurol"},{"key":"2021020117053005000_bibr13-2048872619846329","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1161\/STROKEAHA.109.576140","article-title":"Off-label thrombolysis is not associated with poor outcome in patients with stroke","volume":"41","author":"Meretoja","year":"2010","journal-title":"Stroke"},{"key":"2021020117053005000_bibr14-2048872619846329","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1161\/CIRCULATIONAHA.109.876706","article-title":"Accelerated infusion of streptokinase for the treatment of left-sided prosthetic valve thrombosis: a randomized controlled trial","volume":"120","author":"Karthikeyan","year":"2009","journal-title":"Circulation"},{"key":"2021020117053005000_bibr15-2048872619846329","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1067\/mhj.2000.111109","article-title":"Thrombolytic therapy for prosthetic valve thrombosis: short- and long-term results","volume":"140","author":"Gupta","year":"2000","journal-title":"Am Heart J"},{"key":"2021020117053005000_bibr16-2048872619846329","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients","volume":"3","author":"Schulman","year":"2005","journal-title":"J Thromb Haemost"},{"key":"2021020117053005000_bibr17-2048872619846329","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s11239-006-4969-y","article-title":"Thrombolysis as first choice therapy in prosthetic heart valve thrombosis: a study of 68 patients","volume":"21","author":"Caceres Loriga","year":"2006","journal-title":"J Thromb Thrombolysis"},{"key":"2021020117053005000_bibr18-2048872619846329","first-page":"567","article-title":"Recommendations for the management of prosthetic valve thrombosis","volume":"14","author":"Lengyel","year":"2005","journal-title":"J Heart Valve Dis"},{"key":"2021020117053005000_bibr19-2048872619846329","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/S1010-7940(03)00568-2","article-title":"Surgery for prosthetic valve obstruction: a single center study of 136 patients","volume":"24","author":"Roudaut","year":"2003","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021020117053005000_bibr20-2048872619846329","first-page":"309","article-title":"Fibrinolytic therapy in left side-prosthetic valve acute thrombosis: in depth systematic review","volume":"78","author":"Reyes Cerezo","year":"2008","journal-title":"Arch Cardiol Mex"},{"key":"2021020117053005000_bibr21-2048872619846329","first-page":"1521","article-title":"Guidelines for management of left-sided prosthetic valve thrombosis: a role for thrombolytic therapy: Consensus Conference on Prosthetic Valve Thrombosis","author":"Lengyel","year":"1997"},{"key":"2021020117053005000_bibr22-2048872619846329","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.jcmg.2012.10.016","article-title":"Comparison of different TEE-guided thrombolytic regimens for prosthetic valve thrombosis: the TROIA trial","volume":"6","author":"Ozkan","year":"2013","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021020117053005000_bibr23-2048872619846329","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jacc.2003.08.028","article-title":"Transesophageal echocardiography improves risk assessment of thrombolysis of prosthetic valve thrombosis: results of the international PRO-TEE registry","volume":"43","author":"Tong","year":"2004","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal. Acute Cardiovascular Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2048872619846329","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2048872619846329","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/ehjacc\/article-pdf\/9\/3_suppl\/S58\/36165745\/ehjacc0s58.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjacc\/article-pdf\/9\/3_suppl\/S58\/36165745\/ehjacc0s58.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:19:29Z","timestamp":1618877969000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjacc\/article\/9\/3_suppl\/S58-S62\/6125568"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,1]]},"references-count":23,"journal-issue":{"issue":"3_suppl","published-online":{"date-parts":[[2020,10,1]]},"published-print":{"date-parts":[[2020,10,1]]}},"URL":"https:\/\/doi.org\/10.1177\/2048872619846329","relation":{},"ISSN":["2048-8734","2048-8726"],"issn-type":[{"value":"2048-8734","type":"electronic"},{"value":"2048-8726","type":"print"}],"subject":[],"published-other":{"date-parts":[[2020,10,1]]},"published":{"date-parts":[[2020,10,1]]}}}