Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis

A case of early thrombosis following a percutaneous tricuspid valve in valve implantation managed by thrombolysis

“…Total 158 patients with prosthetic valve thrombosis were enrolled in a multicenter observational study to compare the outcomes of thrombolysis versus surgery as the initial therapeutic method. Low dose t‐pa infusions (25 mg) at a slow (6 h)/ultra‐slow (25 h) rate were accompanied by high success rate (about 90%), lower rate of complications, and 3‐month mortality 18 . In conclusion, thrombolysis is a promising treatment for Mechanical tricuspid valve thrombosis.…”

“…Given the high likelihood of success for thrombolysis in tricuspid prosthetic valve thrombosis, the heart team preferred fibrinolysis to high‐risk 4do surgery. Ultra‐slow infusion of alteplase 1 mg/h for 25 h was chosen since it has been described as an efficient regimen with a low complication rate in the literature 18,19,21 . Although the safety and efficacy of thrombolysis, as well as the best regimen in these situations warrant further investigations, this treatment was shown to be safe and effective without any complication and could be considered in similar cases.…”

“…Low dose t-pa infusions (25 mg) at a slow (6 h)/ultra-slow (25 h) rate were accompanied by high success rate (about 90%), lower rate of complications, and 3-month mortality. 18 In conclusion, thrombolysis is a promising treatment for Mechanical tricuspid valve thrombosis. In a therapeutic outcome study for tricuspid mechanical valve thrombosis, 41 patients received fibrinolytic therapy without experiencing intracranial or gastrointestinal bleeding and only two episodes of retroperitoneal bleeding.…”

Fibrinolytic therapy for prosthetic valve thrombosis: Is the end of controversial story?

“…Standard FT regimens with accelerated and high-dose t-PA may still be associated with higher complication and mortality rates. 2 Recently, several trials have been reported regarding the safety and efficacy of FT regimens with lowdose and slow infusion of t-PA. [2][3][4][5] In the TROIA trial, a low-dose (25 mg) slow infusion (6 h) of t-PA was found to be sufficiently effective and a safer regimen in the management of PVT as compared with high-dose and fast-infusion regimens. 2 Sadeghipour et al 5 indicated that the 25 mg regimen, on the strength of its better safety profile, can be suggested as the reference strategy in the treatment of PVT.…”

“…More recently, we have reported that prolonged infusions of low dose FT are associated with low mortality and complications rates, and providing effective treatment in NYHA class I-IV patients with obstructive PVT and FT may be considered as a beneficial treatment strategy in patients with obstructive PVT in the absence of contraindications. 4 The outcomes of each treatment strategy for PVT have been evaluated by several meta-analyses and systematic reviews. Karthikeyan et al 6 have previously evaluated 690 episodes and seven studies of PVT and found no significant difference in main outcomes (mortality and improvement of valve function) between Surgery and FT.…”