Key result
Tenecteplase was associated with a non-significant trend toward higher complete clinical success (OR 3.14) and significantly lower composite adverse events compared to streptokinase in patients with mitral prosthetic valve obstructive thrombosis.
Why the study?
The optimal thrombolytic therapy agent for prosthetic valve thrombosis is unknown.
Does tenecteplase improve clinical outcomes compared to streptokinase in patients with mitral prosthetic valve obstructive thrombosis?
Cohort (n=84)
No
Does tenecteplase improve clinical outcomes compared to streptokinase in patients with mitral prosthetic valve obstructive thrombosis?
Odds Ratio: 3.14 (95% CI 0.89–10.99)
p-value: p=0.08
In patients with mitral prosthetic valve obstructive thrombosis, tenecteplase infusion is associated with a better safety profile and lower composite adverse event rate compared to streptokinase.
Tenecteplase may be considered over streptokinase for mitral PVT; leaves open need for randomized confirmation.
Agent of choice for thrombolytic therapy (TT) in prosthetic valve thrombosis (PVT) is unknown. 84 mitral obstructive-PVT episodes treated with TT (43: Tenecteplase ; 41: Streptokinase) were included in this prospective study. The incidence of primary end-point (CCS: complete clinical success, defined as complete or partial hemodynamic success with no complications or surgery) was 84.5% with recurrent PVT as a sole predictor. Bleeding and embolic manifestations were noted in 8.3% and 4.7% of episodes respectively. Tenecteplase use was associated with lower complication rate and a mitral EOA of <0.74 cm 2 at presentation predicts the need for extended thrombolysis (accuracy, 78.6%).
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Kiran et al. (2021) conducted a cohort in Mitral prosthetic valve obstructive thrombosis (n=84). Tenecteplase vs. Streptokinase was evaluated on Complete clinical success (complete or partial hemodynamic success with no surgery, bleeding, or embolic features) (OR 3.14, 95% CI 0.89-10.99, p=0.08). Tenecteplase was associated with a non-significant trend toward higher complete clinical success (OR 3.14) and significantly lower composite adverse events compared to streptokinase in patients with mitral prosthetic valve obstructive thrombosis.
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