Key result
Ultra-slow low-dose infusion of tissue-type plasminogen activator successfully resolved mechanical prosthetic mitral valve thrombosis without hemorrhagic or thromboembolic complications.
Why the study?
Prosthetic valve thrombosis is a life-threatening complication where urgent surgery and thrombolytic therapy both carry increased risks for complications and mortality.
Case Report (n=1)
Ultra-slow low-dose systemic thrombolysis with alteplase successfully treated mechanical mitral valve thrombosis without complications in a patient at high surgical risk.
Alerts to prosthetic mitral valve thrombosis on imaging; leaves open optimal management strategies.
Prosthetic valve thrombosis is one of the life-threatening complications in patients with prosthetic heart valves. It is more common in mechanical prosthetic valves in the setting of inadequate or missing anticoagulation. Besides optimization of anticoagulation urgent surgery or thrombolytic therapy should be considered but both are associated with an increased risk for complications and mortality. We report a case of a patient with imaging data for mechanical prosthetic mitral valve thrombosis. Considering the individual patient’s characteristics and the published guidelines we decided to perform systemic thrombolysis with ultra-slow low-dose infusion of tissue-type plasminogen activator. The therapy was successful without any bleeding or thromboembolic complications.
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Dimitrova et al. (2023) conducted a case report in Mechanical prosthetic mitral valve thrombosis (n=1). Systemic thrombolysis (tissue-type plasminogen activator / alteplase) was evaluated on Resolution of thrombosis and reduction of transprosthetic gradients. Ultra-slow low-dose infusion of tissue-type plasminogen activator successfully resolved mechanical prosthetic mitral valve thrombosis without hemorrhagic or thromboembolic complications.
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