Key result
Ultraslow, high-dose t-PA (100mg over 24 hours) completely resolved mechanical prosthetic valve thrombosis in a patient with antiphospholipid syndrome who failed standard low-dose t-PA.
Why the study?
Evidence is limited for managing mechanical prosthetic valve thrombosis that does not respond to standard t-PA dosing in the setting of an exacerbating hypercoagulable condition.
Does ultraslow high-dose t-PA resolve mechanical prosthetic valve thrombosis resistant to standard low-dose t-PA in a patient with antiphospholipid syndrome?
Case Report (n=1)
No
Does ultraslow high-dose t-PA resolve mechanical prosthetic valve thrombosis resistant to standard low-dose t-PA in a patient with antiphospholipid syndrome?
Ultraslow high-dose t-PA (100 mg over 24 hours) successfully resolved refractory mechanical prosthetic valve thrombosis in a patient with antiphospholipid syndrome without bleeding complications.
May support consideration in refractory cases; single case report leaves open need for prospective trials before adoption.
Management of mechanical prosthetic valve thrombosis (PVT) includes medical and surgical options. Standard medical treatment involves thrombolytic therapy with repeated slow infusions of low-dose IV tissue plasminogen activator (t-PA). The evidence for managing mechanical PVT that does not respond to the standard t-PA dosing is limited in the setting of an exacerbating hypercoagulable condition. We present a case of a patient with a history of antiphospholipid syndrome who presented with a probable thromboembolic myocardial infarction secondary to a mechanical mitral valve thrombosis that did not improve with systemic anticoagulation and repeated standard t-PA dosing but rapidly resolved with ultraslow, high-dose t-PA.
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Nyembo et al. (2022) conducted a case report in Mechanical prosthetic valve thrombosis (n=1). Ultraslow, high-dose tissue plasminogen activator (t-PA) vs. Standard ultraslow low-dose t-PA was evaluated on Resolution of thrombus burden and normalization of trans-prosthetic mean gradient. Ultraslow, high-dose t-PA (100mg over 24 hours) completely resolved mechanical prosthetic valve thrombosis in a patient with antiphospholipid syndrome who failed standard low-dose t-PA.
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