Thrombolytic therapy with alteplase followed by oral anticoagulation resolved clinical valve thrombosis after TAVR, restoring valve function without bleeding complications.
Case Report (n=1)
No
Thrombolysis combined with vitamin K antagonist therapy can be an effective rescue treatment for clinical valve thrombosis after TAVR when conservative management with intravenous heparin fails.
Transcatheter aortic valve replacement (TAVR) is an effective therapeutic option for patients with severe symptomatic aortic stenosis who are at high surgical risk. Although generally safe, one of its rare but serious complications is clinical valve thrombosis, occurring in approximately 0.5% of cases. This condition can lead to prosthetic valve dysfunction, worsening heart failure, or thromboembolic events. Diagnosis usually begins with transthoracic echocardiography (TTE), while transoesophageal echocardiography (TOE) and multi-slice computed tomography (MSCT) are often required for more precise assessment. Since standardized treatment protocols are not yet established, management must be individualized according to clinical presentation and the degree of valve obstruction. Therapeutic approaches include oral anticoagulation, intravenous heparin, or, in severe cases with hemodynamic compromise, thrombolytic therapy. If conservative management fails, redo-TAVR or surgical valve explantation may be necessary. We present the case of a 78-year-old Bulgarian woman who developed progressive heart failure 12 days after TAVR. Imaging con rmed bioprosthetic valve thrombosis. Intravenous heparin was ineffective, but thrombolytic therapy followed by oral anticoagulation led to complete thrombus resolution and restoration of valve function without bleeding complications. Clinical valve thrombosis after TAVR, though uncommon, is potentially fatal. MSCT remains the most accurate diagnostic tool, while TOE is valuable for its accessibility. Thrombolysis combined with vitamin K antagonist therapy can be an effective treatment option.
Goranov et al. (Wed,) conducted a case report in 78-year-old female patient from Bulgaria with severe symptomatic aortic stenosis and clinical valve thrombosis after transcatheter aortic valve replacement (TAVR) (n=1). Thrombolytic therapy (alteplase) followed by oral anticoagulation (acenocoumarol) plus clopidogrel vs. Intravenous heparin infusion (initial treatment) was evaluated on Resolution of bioprosthetic valve thrombosis with restoration of valve function and absence of bleeding complications. Thrombolytic therapy with alteplase followed by oral anticoagulation resolved clinical valve thrombosis after TAVR, restoring valve function without bleeding complications.