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Use of tenecteplase for left-sided prosthetic valve thrombosis
Vinod Sharma1, Ruchi Singh, Rekha Mishra
1National Heart Institute, New Delhi.
Insights
Tenecteplase effectively treats prosthetic valve thrombosis (PVT) in rheumatic heart disease patients, showing significant gradient reduction and normal valve motion without major complications. This study offers the largest evidence for tenecteplase
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Prosthetic valve thrombosis (PVT) is a frequent complication after cardiac valve replacement in rheumatic heart disease patients.
- While surgery is traditional, thrombolytic therapy shows promise for PVT management.
Purpose of the Study:
- To evaluate the efficacy and safety of tenecteplase for treating left-sided prosthetic valve thrombosis.
Main Methods:
- A case report involving ten patients with left-sided PVT treated with tenecteplase.
- Treatment included tenecteplase, enoxaparin, heparin, and acenocoumarol.
- Trans-thoracic echocardiography assessed diagnosis and response, measuring transvalvular gradients and valve motion.
Main Results:
- Significant reduction in peak transvalvular gradient (46%-81%) and mean transvalvular gradient (50%-84%).
- Complete normalization of valve motion observed in all patients.
- No mortality, intracerebral hemorrhage, systemic bleeding, or embolism occurred.
Conclusions:
- Tenecteplase demonstrates high efficacy and safety in treating prosthetic valve thrombosis.
- This study represents the largest published evidence supporting tenecteplase for PVT.
Introduction:
Prosthetic valve thrombosis (PVT) following cardiac valve replacement in rheumatic heart disease patients is a common cause for referral to tertiary care centre. Although surgery has been described as the traditional choice of therapy, thrombolytic therapy has reported high success rates in published literature.
Case Report:
This is a case report of ten patients with left-sided PVT receiving tenecteplase. The mean dose of tenecteplase used was 1.01 mg/kg given as IV bolus injection along with enoxaparin, heparin and acenocoumarol. The diagnosis and response was assessed based on trans-thoracic echocardiography. The reduction in peak transvalvular gradient was in the range of 46% - 81% and in mean transvalvular gradient was in the range of 50% - 84%. There was normalization of valve motion in all patients. There was no incidence of mortality, intracerebral hemorrhage, systemic bleeding or embolism.
Conclusion:
To our knowledge, this is the largest published evidence so far showing efficacy and safety of tenecteplase for PVT.
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