Key result
Alteplase infusion successfully relieved prosthetic mitral valve thrombosis in 19 of 20 attempts (95%) in paediatric patients without major bleeding complications.
Why the study?
Optimal management of paediatric prosthetic valve thrombosis is debated, and there is limited use of thrombolytic therapy in children with valve thrombosis.
Does alteplase infusion relieve prosthetic mitral valve thrombosis in paediatric patients?
Observational (n=10)
No
Does alteplase infusion relieve prosthetic mitral valve thrombosis in paediatric patients?
Alteplase infusion at 0.1 to 0.3 mg/kg/hour appears to be a safe and effective strategy for managing prosthetic mitral valve thrombosis in the pediatric population.
Alteplase may be feasible for pediatric prosthetic valve thrombosis; hypothesis-generating and requires prospective validation before practice change.
INTRODUCTION: The incidence of prosthetic valve implantation is increasing in the paediatric population. Prosthetic valve thrombosis leading to obstruction could potentially be a life-threatening complication. There is a debate regarding optimal management of this complication, and there is limited use of thrombolytic therapy in childhood in the setting of valve thrombosis. OBJECTIVE: We aim to share our experience of successfully using fibrinolytic therapy in terms of alteplase for paediatric prosthetic mitral valve thrombosis and to propose a management algorithm. METHODS: This retrospective analysis of the database was conducted at our hospital including patients who underwent thrombolysis (alteplase) for prosthetic mitral valve thrombosis from June, 2011 to June, 2021. A total of 10 patients with 20 attempts of alteplase infusion were found in our record. RESULTS: Alteplase was successful in 19 attempts to relieve valve thrombosis. The safe and effective dose of alteplase was between 0.1 and 0.3 mg/kg/hour. There were no associated major bleeding complications and alteplase was administered either by central or peripheral line. CONCLUSION: Thrombolysis by alteplase infusion was found to be successful in relief of prosthetic mitral valve thrombosis in paediatric population without major bleeding complications.
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Mashali et al. (2022) conducted an observational in Prosthetic mitral valve thrombosis (n=10). Alteplase was evaluated on Relief of valve thrombosis. Alteplase infusion successfully relieved prosthetic mitral valve thrombosis in 19 of 20 attempts (95%) in paediatric patients without major bleeding complications.
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