High prevalence of silent brain infarction in patients presenting with mechanical heart valve thrombosis.

BACKGROUND

Symptomatic thromboembolic events including stroke occur frequently in patients with mechanical heart valves, particularly among those who are poorly anticoagulated.

OBJECTIVE

This study set out to determine the prevalence of silent brain infarction (SBI) in this population.

METHODS

This was a post hoc analysis of data from a randomized controlled trial carried out in a tertiary-care academic medical center. The trial included participants from a randomized controlled trial of fibrinolytic therapy (FT) in patients with left-sided prosthetic valve thrombosis (PVT), who had undergone pre-treatment computed tomography (CT) scans of the brain. The prevalence of SBI in this population was investigated.

MAIN OUTCOME MEASURE: Prevalence of silent brain infarction.

RESULTS

Silent brain infarction was present in 27 of 72 patients (37.5%; 95% confidence interval [CI] 27.2, 49.1). Most patients with SBI (57; 82.6%) had sub-therapeutic anticoagulation at presentation. We identified baseline characteristics that were associated with the presence of SBI using a logistic regression model. Atrial fibrillation (AF) was strongly associated with the presence of SBI (odds ratio [OR] 5.60; 95% CI 1.32, 23.87; p = 0.02).

CONCLUSION

The high prevalence of SBI among this cohort of young patients with mechanical heart valves is alarming and calls for urgent efforts to improve the quality of anticoagulation.

CLINICAL TRIAL REGISTRATION: Registered in the US National Institutes of Health registry at http://clinicaltrials.gov as NCT00232622.