ABSTRACT
Background: There is limited data available about the effectiveness of thrombolysis in prosthetic valve thrombosis (PVT). Therefore, this study aimed to evaluate the efficacy and safety of thrombolytic treatment in PVT patients.Methods: This was an observational study conducted at a tertiary-care centre in India between March 2013 and April 2014. Total of 56 patients with either recurrent PVT or with confirmed left-sided PVT was included in the study. Thrombolytic therapy was administered as an intravenous infusion of streptokinase or urokinase, initially at a loading dose of 2.5L IU/hour over 30 minutes, followed by 1L IU/hour for 48–78 hours depending upon the clinical and 2D-Echo observation. Primary endpoint was considered as the occurrence of a complete clinical response. Secondary endpoint was considered as a composite of death, major bleeding or embolic stroke.Results: Mean age of the patients was 37±13 years. Most of the patients presented with NYHA-II (51.7%), III (39.2%), and IV (8.9%) symptoms. Mitral and aortic valve thrombosis were observed in 40(71.4%) and 11(28.6%) patients. Forty-nine (73.3%) patients were treated with streptokinase. Whereas, rethrombosis patients were treated with urokinase [6(16%)] and tenecteplase [1(1.3%)]. Two (3.6%) patients died, 1(1.8%), 1(1.8%), 2(3.6%), and 1(1.8%) patient had peripheral embolism, central nervous system bleeding, stroke, and embolic complications.Conclusions: Thrombolytic therapy can be used as the first-line treatment for thrombolysis in PVT patients. All PVT patients can be treated with streptokinase unless specific contraindications exist. Urokinase or tenecteplase is an alternative thrombolytic agent in rethrombosis patients.
ABSTRACT
Background: We aimed to compare clinical profile of premature coronary artery disease (PCAD) in urban vs. rural Indian populations.Methods: This was a prospective cross-sectional observational multi-centre study. This study is a sub-study of the ongoing PCAD registry. Between the period April 2017 and April 2018, a total of 1061 patients <40 years with PCAD were studied. Urban (n=583) and rural (n=478) populations were statistically compared.Results: Mean age of the urban and rural populations were 34.50±4.15 years and 33.99±4.46 years, respectively. All cardiovascular risk factors (smoking, diabetes, hypertension, dyslipidemia, obesity, diet and family history), except for alcoholism were more prevalent in urban subjects compared to rural subjects. However, higher prevalence of only hypertension (p=0.05) was statistically significant. Religion was significant between the two populations (p<0.001). Window period was also significant between the two populations (p<0.001). Very low density lipoprotein cholesterol (VLDL) (p=0.037) was significantly different between both populations.Conclusions: All conventional risk factors were more prevalent among urban populations than rural populations, however none of these differences except for hypertension was statistically significant.