Evaluation On The Thrombolytic Effect Of Urokinase On The Patients Of Mitral Stenosis With Left Atrial Thrombus

Objective: To investigate the therapeutic effect of urokinase intravenous injection on rheumatic mitral stenosis (MS) patients combining with left atrial thrombi, and analyze the differences of effect. It is beneficial for trying for surgical time and creating conditions for surgery as soon as possible that investigate monitoring convenience and the method of shorting left atrial thrombus'treatment cycles.Methods: 29 MS patients combining with left atrial thrombi ,which were in the First Affiliated Hospital of Guangxi Medical University from October 2008 to November 2009, Received the treatment of urokinase with the monitoring of transthoracic echocardiography. Observing the efficacy and safety of urokinase on the treatment period of left atrial thrombi and the period of the application via balloon mitral dilatation (Percutaneous ballon mitral valvuloplasty, PBMV), and compared with the thrombus size, left atrial size, medical history, whether mild mitral regurgitation,mitral pressure half-decline time between patients with successful thrombolytic therapy and patients failure thrombolytic therapy, analyzed the reasons for success of thrombolytic effect.Results: The time of thrombolysis was 12.9±5.4 day. Complete thrombolysis 20 patients (69%), significantly reducing 5 patients (17%), no significant changes 4 cases (14%). Complete thrombolysis time was 10.6±4.5 day. Before thrombolysis and 3 days after thrombolysis, coagulation parameters were no statistical significance (P> 0.05), before thrombolytic therapy and 7 days after thrombolysis, coagulation parameters prothrombin time and activated partial thromboplastin time were not significant ( P> 0.05), plasma fibrinogen levels was lower than before (P <0.05), thrombin time extended (P <0.05), no severe bleeding and thrombosis complication. The left atrial thrombus size was significantly different compared with successful thrombolysis patients and failure thrombolytic therapy patients (P <0.05); It was significant difference that whether use of warfarin before thrombolysis between winners and losers (P <0.05 ); Contrast thrombolytic winners with thrombolytic losers , the length of medical history, left atrial size and mitral pressure half-decline time were significantly different (P> 0.05). The subjective symptoms of 20 patients with routine PBMV surgery were improved; Diastolic murmurs disappeared or significantly decreased in mitral auscultation area; mitral valve area increased significantly (P <0.01), left atrial mean pressure was significantly decreased (P <0.01), success rate 100%, no severe bleeding and embolism complications intraoperative.Conclusions: That Urokinase cures left atrial thrombi is effective and safe. Comparing to warfarin applications, Urokinase is more convenient, shorter treatment cycles.