Successful thrombolysis of a thrombosed prosthetic mitral valve using a synthetic tissue plasminogen activator: a case report

Al-Sarraf, Nael; Al-Shammari, Fahad; Al-Fadhli, Jamal; Al-Shawaf, Emad

doi:10.1186/1752-1947-4-241

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…[5] Our patient was symptomatic for 1 month. As Tenecteplase is more fibrin specific, easy to administer and we had previously used it successfully in Mitral valve thrombosis, [6] we felt it was a good choice. In case thrombolysis had failed, re-exploration and redo aortic valve replacement was planned.…”

Section: Discussionmentioning

confidence: 94%

Successful thrombolysis of a thrombosed mechanical aortic valve prosthesis using a slow intravenous Tenecteplase infusion

Mohamed

Alruwaih²,

Al-Sarraf³

et al. 2016

Int Arch Med

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Section: Discussionmentioning

confidence: 94%

Successful thrombolysis of a thrombosed mechanical aortic valve prosthesis using a slow intravenous Tenecteplase infusion

Mohamed

Alruwaih²,

Al-Sarraf³

et al. 2016

Int Arch Med

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“…There are no clear guidelines on the dosage of TNK in PVT. The previous reports had utilized the dose of 30mg (0.5mg per kg as IV infusion) 18 and 40mg as IV bolus dose. In contrast, the dosage of TNK in our study was higher i.e.…”

Section: Discussionmentioning

confidence: 99%

Comparative safety and efficacy of tenecteplase and streptokinase in prosthetic valve thrombosis: An observation from Eastern India

Mishra

Mishra²,

Dash³

et al. 2022

PJMS

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Prosthetic valve thrombosis (PVT) is a life-threatening emergency. Thrombolytic therapy is emerging as a potential substitute. The objective of this study was to assess the safety and efficacy of Tenecteplase (TNK) in comparison to streptokinase (STK) in patients with PVT. In this prospective study, patients with PVT who were not subjected to the surgery underwent thrombolysis with TNK (TNK arm) or STK (STK arm). Efficacy and safety of both treatment arms were judged from clinical, echocardiographic (ECHO), and Cinefluoroscopic parameters. Treatment outcomes and complications were compared between the two arms.Between December 2017 and December 2019, a total of 41 cases of PVT were enrolled to receive either TNK (n=23) or STK (n=18). After thrombolysis, complete recovery was significant in the TNK arm (82.6% [19/23] vs. 44.4% [8/18], respectively; p=0.007) irrespective of the valve position. This trend was observed in both mitral PVT (85.7% vs. 46.6%, respectively; p=0.03) and aortic PVT (77.8% vs. 33.3%, respectively; p=0.151). No failure was seen in the TNK arm but failure was observed in 1/3cases in the STK arm. No major bleeding was observed with either treatment. Minor bleeding and systemic embolization were non-significant (P=0.514). There were no deaths in the TNK arm but two patients (11%) from the STK arm died.To our knowledge, this is the largest published comparative evidence indicating superior efficacy and equal safety of tenecteplase compared to streptokinase for the treatment of prosthetic valve thrombosis irrespective of valve position and NYHA class.

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“…The rationale behind the continuous low dose infusion is to avoid rapid lysis and reduce the rate of complications, while the reasoning behind a large brief loading dose with 100 mg t-PA over 90 minutes is to expedite the resolution of a clot and quickly restore any hemodynamic instability, if present, and prevent the risk of its progression further [21] . However, one study used the regimen of TPA 0.5 mg per kilogram body weight and 1.25 mg per hour infusion for 48 hours with successful results [22].…”

Section: Discussionmentioning

confidence: 99%

Successful Thrombolytic Treatment of a Thrombosed Mechanical Mitral Valve in a Post-brain Surgery Patient- A Case Report and Literature Review

Alshamiri¹

2019

Angiol Open Access

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The first-line management of prosthetic valve thrombosis is not yet finalized; dealing with such cases remains a clinical challenge and requires prompt detection, timely diagnosis and individualized case management regardless of whether the case in question requires a surgical or medical therapeutic approach. We report a unique case of mechanical mitral valve thrombosis post Bentall procedure with a double aortic-mitral valve replacement in a patient who previously underwent brain surgery after experiencing a Road Traffic Accident (RTA). The patient was successfully treated by using a combined loading and infusion regimen of tissue-Plasminogen Activators (t-PA). A small loading dose of 15 mg followed by a low-dose slow infusion of t-PA has been shown to provide effective and safe thrombolysis in high-risk patients with prosthetic valve thrombosis.

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Successful thrombolysis of a thrombosed prosthetic mitral valve using a synthetic tissue plasminogen activator: a case report

Cited by 5 publications

References 11 publications

Successful thrombolysis of a thrombosed mechanical aortic valve prosthesis using a slow intravenous Tenecteplase infusion

Successful thrombolysis of a thrombosed mechanical aortic valve prosthesis using a slow intravenous Tenecteplase infusion

Comparative safety and efficacy of tenecteplase and streptokinase in prosthetic valve thrombosis: An observation from Eastern India

Successful Thrombolytic Treatment of a Thrombosed Mechanical Mitral Valve in a Post-brain Surgery Patient- A Case Report and Literature Review

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