Treatment Percutaneous Mitral Balloon Valvotomy
ÎFor patients being considered for percutaneous mitral balloon valvotomy (PMBV) with preprocedural transesophageal echocardiography (TEE) showing left atrial thrombus, the ACCP recommends that PMBV be postponed and that VKA therapy (target INR 2.5-3.5) be administered until thrombus resolution is documented by repeat TEE over no VKA therapy (1-A).
ÎFor patients being considered for PMBV with preprocedural TEE showing left atrial thrombus, if the left atrial thrombus does not resolve with VKA therapy, the ACCP recommends that PMBV NOT be performed (1-A).
Infective Endocarditis
ÎIn patients with infective endocarditis (IE), the ACCP recommends AGAINST routine anticoagulant therapy, unless a separate indication exists (1-C).
ÎIn patients with IE, the ACCP recommends AGAINST routine antiplatelet therapy, unless a separate indication exists (1-B).
ÎIn patients with nonbacterial thrombotic endocarditis and systemic or pulmonary emboli, the ACCP suggests treatment with full-dose intravenous (IV) unfractionated heparin (UFH) or subcutaneous low-molecular-weight heparin (LMWH) over no anticoagulation (2-C).
Prosthetic Valves
ÎIn patients on VKA for a prosthetic valve who develop IE, the ACCP suggests VKA be discontinued at the time of initial presentation until it is clear that invasive procedures will not be required and the patient has stabilized without signs of central nervous system involvement. When the patient is deemed stable without contraindications or neurologic complications, the ACCP suggests reinstitution of VKA therapy (2-C).
ÎFor patients with left-sided prosthetic valve thrombosis (PVT) and large thrombus area (≥ 0.8 cm2
ÎFor patients with left-sided PVT and small thrombus area (< 0.8 cm2 ), the ACCP suggests early surgery over fibrinolytic
therapy (2-C). If contraindications to surgery exist, the ACCP suggests the use of fibrinolytic therapy (2-C).
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ACCP suggests administration of fibrinolytic therapy over surgery. For very small, nonobstructive thrombus the ACCP suggests IV UFH accompanied by serial Doppler echocardiography to document thrombus resolution or improvement over other alternatives (2-C).
ÎFor patients with right-sided PVT, in the absence of contraindications the ACCP suggests administration of fibrinolytic therapy over surgical intervention (2-C).
