Efficiency of Thrombolytic Therapy in Mechanical Prosthetic Valve Thrombosis: A Comprehensive Study from a Tertiary Care Center

Background: Prosthetic valve thrombosis (PVT) is a life-threatening condition with high morbidity and mortality rates. Despite patient education on maintaining mechanical valves, PVT remains a significant issue. Aims and Objectives: This study aims to evaluate the incidence and clinical characteristics of prosthetic valve thrombosis (PVT) in patients with mechanical valve replacements and assess the efficacy of thrombolysis using streptokinase as the primary treatment. It seeks to identify factors contributing to PVT development, investigate morbidity and mortality rates associated with thrombolysis, and propose strategies to reduce PVT incidence through improved patient management and follow-up protocols. Materials and Methods: This retrospective study analyzed 500 valve replacement patients (aged 25-71) from January 2013 to December 2023. PVT was diagnosed in 32 patients using echocardiography and fluoroscopy, and thrombolysis with streptokinase was the primary treatment. Results: Among the 32 PVT cases, 90.62% involved mitral valves, and 71.87% of patients were female. The median age was 37.45 years, and the mean time to PVT presentation was 48.13 months. Thrombolytic therapy had an 84.37% success rate, with in-hospital survival at 90.62%. Complications included hypotension (31.25%) and cerebrovascular accident (3.12%) and an in-hospital mortality rate of 9.37%. Conclusion: The study emphasizes the importance of proper anticoagulation to prevent prosthetic valve thrombosis, particularly in mitral valves. Subtherapeutic INR significantly increases the risk of a stuck valve. Streptokinase thrombolysis is highly effective, especially where cardiac surgery is unavailable, with high survival and manageable complications.