Outcomes of Thrombolysis for Left-Sided Mechanical Valve Thrombosis: A 10-Year Retrospective Study

BackgroundThrombolysis remains a key treatment for mechanical left-sided valve thrombosis, but outcomes vary across agents and patient groups. We evaluated thrombolysis effectiveness and predictors of failure in a large single-center cohort.MethodsWe performed a retrospective cohort study of all patients with mechanical left heart valve thrombosis treated with thrombolysis at the Narayana Institute of Cardiac Sciences, Bangalore, from January 2013 to December 2023. Clinical, echocardiographic, and treatment data were obtained from the emergency registry and medical records. The primary outcome was successful thrombolysis, defined as complete restoration of valve function on echocardiography by hospital discharge without in-hospital complications. Logistic regression identified determinants of failure (p < 0.05 significant).ResultsWe analyzed 190 patients (median age 43 years, IQR 36-52; 50% female). Bi-leaflet valves were present in 81.1%, and streptokinase was most frequently used (57.9%). Overall, 145 patients (76.3%) achieved successful thrombolysis, while 45 (23.7%) failed treatment. Major ischemic events occurred in 7.4%, hemorrhage in 1.6%, and 13 patients (6.8%) died. On multivariable analysis, failure was independently associated with female sex (aOR 2.59, 95% CI 1.13-5.92), double valve replacement (aOR 6.40, 95% CI 2.48-16.56), anemia (aOR 5.02, 95% CI 1.55-16.28), streptokinase use (aOR 3.05, 95% CI 1.11-8.33), and absence of fluoroscopy prior to therapy (aOR 3.77, 95% CI 1.59-8.95).ConclusionThrombolysis achieved a 76.3% success rate, consistent with global reports. Tenecteplase showed greater success and fewer complications than streptokinase. Accounting for sex, valve type, anemia, and fluoroscopy may improve outcomes in mechanical valve thrombosis.