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Fibrinolysis versus Urgent Surgery in Obstructive Prosthetic Valve Thrombosis: Updated Evidence from a Systematic Review and Meta-Analysis
Session:
Sessão de Posters 51 - Circulação pulmonar, pericárdio e cuidados agudos
Speaker:
Bernardo Lisboa Resende
Congress:
CPC 2026
Topic:
L. Cardiovascular Pharmacology
Theme:
31. Pharmacology and Pharmacotherapy
Subtheme:
31.5 Pharmacology and Pharmacotherapy - Other
Session Type:
Posters Eletrónicos
FP Number:
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Authors:
Bernardo Resende; Emídio Mata; Ana Marta Pinto; Margarida Castro; Tomás Carlos; Luísa Rocha; Miguel Vicente; Sílvia Ribeiro; João Gameiro; António Lourenço; Gonçalo Ferraz-Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Background: </strong>Obstructive prosthetic valve thrombosis (PVT) is a rare but life-threatening complication. The optimal first-line therapy remains debated. While surgery has historically been preferred, advances in low-dose, slow-infusion alteplase protocols have improved fibrinolysis outcomes. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Methods:</strong> Following a systematic search of five databases, we conducted a systematic review and meta-analysis compared fibrinolysis with urgent surgery for obstructive PVT. The co-primary outcomes were in-hospital all-cause mortality and complete valve function restoration. Secondary outcomes included stroke, systemic embolization, major bleeding, recurrent PVT, and <span style="background-color:white"><span style="color:black">all-cause mortality during follow-up</span></span>. Data were pooled using random-effects models, with sensitivity and meta-regression analyses. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Results: </strong>Across 12 observational studies and 1 randomized controlled trial, 1300 patients (586 fibrinolysis, 714 surgery) were included. No significant difference was observed in in-hospital mortality (RR 0.62, CI 0.32–1.21; I²=57%). However, fibrinolysis was associated with lower complete valve function restoration (RR 2.02, CI 1·25–3.27; I²<span style="color:black">=70%</span>) and higher risks of stroke (RR 3.57, CI 1.36–9.34; I²<span style="color:black">=0%</span>), systemic embolization (RR 3.88, CI 1.16–13.0; I²<span style="color:black">=0%</span>), and recurrent PVT (RR 2.46, CI 1.26–4.82; I²<span style="color:black">=58%</span>). No differences were found in major bleeding or <span style="background-color:white"><span style="color:black">all-cause mortality during follow-up</span></span>. Sensitivity analyses restricted to alteplase-based regimens favored fibrinolysis, showing lower in-hospital mortality (RR 0.12, CI 0.04–0.40; I²<span style="color:black">=0%</span>) with efficacy comparable to surgery. </span></span></p> <p style="text-align:justify"><span style="font-family:Times New Roman,Times,serif"><strong><span style="font-size:12.0pt">Conclusion: </span></strong><span style="font-size:12.0pt">Surgery offers definitive clot removal with higher immediate success and fewer embolic or recurrent events. Low-dose alteplase protocols achieve outcomes approaching surgery with improved safety. Given the low certainty of available evidence, treatment should be individualized according to patient risk profile, surgical expertise, and institutional resources.</span> </span></p>
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