Thrombolytic Therapy with Recombinant Streptokinase for Prosthetic Valve Thrombosis

BACKGROUND: Thrombosis is a serious complication of prosthetic heart valves, and management is often difficult. Thrombolytic therapy is a promising alternative to valve re-operation in the prosthetic valve thrombosis. METHODS: Fifteen consecutive patients with prosthetic heart valve thrombosis (10 mitral, 3 aortic, 2 tricuspid) were treated with intravenous recombinant streptokinase: 250,000 UI given over 30 minutes followed by an infusion an 100,000 UI per hour, always with clinical monitoring and echocardiographic examinations repeated at 24, 48, and 72 hours after starting thrombolytic therapy. Doppler echocardiography was the primary method use for diagnosis and was also used to follow the response to therapy RESULTS: Fibrinolytic treatment was successful in 14 (93.3%) patients. Total response was achieved in 13 (86.6%)patients and partial response in 1 (6.7%) patient; one patient died of ventricular fibrillation. No major hemorrhagic events were observed, peripheral embolism occurred in two cases, and one case of minor peripheral bleeding occurred in another. Some patients experienced fever and chills. CONCLUSIONS: The present study demonstrates the feasibility, safety and efficacy of thrombolytic therapy, which may be considered as first-line therapy for prosthetic heart valve thrombosis.