Tenecteplase versus streptokinase thrombolytic therapy in patients with mitral prosthetic valve thrombosis

Kathirvel, D.; Gnanaraj, Justin Paul; Kumar, G Prathap; Palanisamy, Gopinath S.; Gnanavelu, G.; Ravishankar, G.; Swaminathan, N.; Venkatesan, S.

doi:10.1016/j.ihj.2017.10.014

Cited by 14 publications

(10 citation statements)

References 13 publications

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“…We have read with great interest the article by Kathirvel et al which was recently published in the Indian Heart Journal 1 . We commend the authors for this important report describing clinical outcomes with tenecteplase (TNK) versus streptokinase thrombolytic therapy (TT) in patients with mitral prosthetic valve thrombosis (PVT).…”

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confidence: 99%

Two and real-time three dimensional transesophageal echocardiography guided thrombolytic therapy for prosthetic valve thrombosis is crucial

Güner

Kalkan

Özkan

2018

Indian Heart Journal

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confidence: 99%

Two and real-time three dimensional transesophageal echocardiography guided thrombolytic therapy for prosthetic valve thrombosis is crucial

Güner

Kalkan

Özkan

2018

Indian Heart Journal

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“…5,6 There is only a single study which studied infusion of tenecteplase 0.5 mg/kg over 24 hours. 7 Studies by Ozkan et al have shown that using lowering the dose and prolonging the infusion with alteplase lead to higher success rates with reduced bleeding. 8,9 Our patient had ongoing haemoptysis as a consequence of prosthetic heart valve thrombosis, which needed to be treated keeping in mind the bleeding risk associated with thrombolysis.…”

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confidence: 99%

Unusual presentation of mitral prosthetic heart valve thrombosis managed with low dose tenecteplase infusion

Ahmed

Gupta

2021

Cardiol Young

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A 11-year-old with history of mitral valve replacement presented with low-grade fever, breathlessness and multiple episodes of haemoptysis for 2 days. Detailed echocardiographic evaluation revealed possible prosthetic valve thrombosis, which was confirmed by fluoroscopy. She was thrombolysed with low dose infusion of tenecteplase. Post thrombolysis her symptoms improved, valve mobility was restored, and haemoptysis subsided. Left sided prosthetic valve thrombosis presenting predominantly with haemoptysis is very rare.

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“…Streptokinase was used in the majority of patients 66.7% and tenecteplase and reteplase was used in 2 patients each. In a study conducted by Kathirvel et al 76.9 % of patients were thrombolysed with STK and 23.1 percent were thrombolysed with TNK [26]. In the study conducted by Hiracharan et al 86.9 % of patients were thrombolysed with STK and 13.1% were thrombolysed with TNK [18].…”

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confidence: 98%

“…Streptokinase had been used as a first-line drug in most studies [19] [23-26]. Newer fibrinolytics are also equally efficacious for the treatment of PVT [26][31] [32].…”

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confidence: 99%

"Study Of Clinical Characteristics and Risk Determinants Of Patients With Prosthetic Valve Thrombosis: A Tertiary Care Hospital-Based Observational Study"

Asotra¹

2021

ACR

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Introduction: Prosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The present study aims to evaluate patients with prosthetic valve thrombosis in terms of the clinical characteristics, risk determinants, treatment, and outcomes in the prospective observational study. Material and Methods:The observational study was conducted in a tertiary care center. All patients suspected of having prosthetic valve dysfunction underwent clinical, echocardiography, and fluoroscopic examination. Data regarding risk determinants, clinical characteristics, and response to treatment was categorized on the basis of serial echocardiography and fluoroscopy into 3 classes; complete response, partial response, and failed treatment.Result: Out of 29 patients 17 (59%) were females and 12 (41%) were males. The mean age was 46.6years with an age range from 20-80 years. 15 (52%) patients were post MVR, 9 (32%), post DVR and 5 (17%) were post AVR. Dyspnoea was the presenting complaint in all the patients presenting with valve thrombosis. Mitral valve thrombosis was seen in 19 (65%), aortic valve thrombosis in 8 (28%), and tricuspid valve thrombosis in 2 (7%). 86% of patients had sub-therapeutic INR. Intensification of anticoagulation and thrombolytic therapy was the treatment modalities deployed.76% of patients received thrombolytic therapy and streptokinase was the most common agent used in 82% of patients. Majority of patients presented with symptoms of NYHA class III. 62% of patients showed complete response, 24% of patients showed partial response, and 4 (14%) had no response to lytic therapy. 7 out of 29 patients landed up in complications. 4 out of 29 patients had minor bleeds in the form of oral mucosal ooze and haematuria. 3 patients succumbed to complications, one of whom had a major bleed in the form of intracranial hemorrhage and two had worsening of heart failure. Conclusion:The most important risk factor attributed to the occurrence of prosthetic valve thrombosis was non-compliance to treatment leading to subtherapeutic INR. Mitral valve thrombosis was most commonly seen and Fibrinolysis can be considered as effective therapy even in patients presenting with NYHA Class III/IV especially in resource-stricken developing countries.

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Tenecteplase versus streptokinase thrombolytic therapy in patients with mitral prosthetic valve thrombosis

Abstract: Slow infusion of TNK is equally efficacious but more effective than SK in the management of mitral mechanical PVT. 75% to 77.5% of PVT patients completely recovered from TT and it should be the first line therapy where the immediate surgical options were remote.

Cited by 14 publications

References 13 publications

Two and real-time three dimensional transesophageal echocardiography guided thrombolytic therapy for prosthetic valve thrombosis is crucial

Two and real-time three dimensional transesophageal echocardiography guided thrombolytic therapy for prosthetic valve thrombosis is crucial

Unusual presentation of mitral prosthetic heart valve thrombosis managed with low dose tenecteplase infusion

"Study Of Clinical Characteristics and Risk Determinants Of Patients With Prosthetic Valve Thrombosis: A Tertiary Care Hospital-Based Observational Study"

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