Este foi o resultado após 24 horas da administração da droga
Recomendo a leitura deste artigo
1. All patients with suspected TPVs should undergo echocardiographic study. If adequate visualization of the prosthetic valve is not obtained by a transthoracic study, then a transesophageal echocardiographic study should be undertaken (level of evidence I).
2. Patients with right-sided TPVs should be treated with intravenous rtPA (100 mg administered as 10 mg immediate intravenous bolus followed by 90 mg infused over 90 min) or SK (500,000 IU over 20 min followed by 1.5 million IU infused over 10 h). Reduced doses should be employed in children and very small adults (level of evidence IIa).
3. Patients who are critically ill on presentation with TPV (pulmonary edema, hypotension, NYHA class III/IV symptoms) should receive immediate intravenous thrombolytic therapy as outlined earlier following appropriate echocardiographic confirmation of TPV (level of evidence IIa.
a. Serial echocardiographic studies should be performed in these individuals, and repeated infusions of thrombolytic therapy should be administered if complete resolution of prosthetic valve thrombus is not achieved (level of evidence IIa).
b. Concomitant intravenous unfractionated heparin should be administered along with thrombolytic therapy to achieve an activated partial thromboplastin time that is 1.5 to 2.0 times control (level of evidence IIb).
c. Cardiac surgical consultation should be sought urgently. Valve replacement should be seriously considered if repeated infusions of thrombolytic therapy fail to adequately dissolve the thrombus on the prosthetic valve (level of evidence IIa).
4. Patients with TPV who are clinically stable, that is, in NYHA clinical class I or II, may be managed medically with thrombolytic/antithrombotic therapy or surgically with valve replacement depending on physician/patient preference (level of evidence IIa).
Esta tabela é de um artigo tailandês!!!
Chegou a ver uso de Metalyse nestes casos? A trombose a Direita é mais grave do que a esquerda?
ResponderExcluirDurães, nos maiores trabalhos que vi, nenhum deles utilizou tecneteplase. Trombose em próteses valvares a direita são mais comuns que a esquerda (proporcionalmente, claro) e respondem muito bem a trombólise.
ResponderExcluirAbaixo segue um protocolo publicado Heart 2007;93:137–142
In patients with haemodynamic instability, ‘‘rescue’’ fibrinolysis should be preferred, using a ‘‘short protocol’’ consisting of either:
- recombinant tissue plasminogen activator (rtPA) 10 mg
bolus + 90 mg in 90 mins, or
- streptokinase 1 500 000 U in 60 mins without heparin.
In haemodynamically stable patients, a long protocol is often
preferred using either:
- urokinase 4500 U/kg/h over a 12 h period, or 2000 U/kg/h +
heparin over 24 h, streptokinase 500 000 IU in 20 mins
followed by 1 500 000 IU for 10 h without heparin
- rtPA 10 mg bolus, 50 mg during the first hour, 20 mg during
the second hour and 20 mg during the third hour.