3-5 Recurrent thrombosis
There were 24 episodes of recurrent mechanical TV dysfunction due to
thrombosis. Of these episodes, 10 occurred following thrombolytic
therapy, 8 after anticoagulant intensification, and 6 following surgical
procedure. There was significantly shorter mean of interval between
recurrent events and previous thrombolytic treatment than surgery (13.2
± 14.1, 95% confidence interval [CI] 5.8-20.5 vs. 66 ± 36, 95% CI
36.8-95.1 months, p <0.001), in) Table 3( . With
respect to the choice of treatment and response to therapy, in recurrent
episodes following previous thrombolytic therapy, five (50%) cases
received fibrinolytic again as the treatment option; of which three
(60%) were successful and two (40%) cases required subsequent surgery
due to failed thrombolytic treatment. In recurrent episodes following
previous redo TV replacement, five (83.3%) cases received successful
fibrinolytic therapy. Although, five (62%) episodes with partial
response in our study were a recurrent episode, there was no
statistically significant association regarding treatment response in
recurrence and non-recurrence episodes (the thrombolytic success rate
was 66.7% in episodes which were not a recurrence).
Sixteen (38%) patients presented with at least one episode of recurrent
thrombosis during the median follow-up time of 31.1 months (0.53-155.9).
Kaplan-Meier estimation for freedom from the first recurrence of
thrombosis revealed that at the end of first 2 years irrespective of the
treatment strategy, 84% of patients were free of recurrent thrombosis;
however, this declined to 61% and 21% at the end of 4 and 10 years,
respectively. The median time for the first recurrence in patients was
85.5 months (95% CI 41.8-129.2), (Fig. 2).