Outcomes of thrombolytic therapy in prosthetic valve thrombosis; a single centre study

To determine the outcomes of thrombolytic therapy in prosthetic valve thrombosis.

Data was taken from the hospital discharge database, of the Tahir Heart Institute, for patients admitted from January 01, 2016 to June 30, 2024. Definitive diagnosis was made with transthoracic echocardiography showing an obstructed prosthetic valve for patients presenting with new-onset dyspnea. Streptokinase infusion was given per ACC/AHA guidelines with twelve-hourly TTE for transvalvular gradient assessment. The primary outcome was successful thrombolysis with reduction in transvalvular gradients. Data was analyzed by Microsoft Excel. Patients were followed up over time.

Approximately 0.1% of total hospital admissions, i.e. twenty-seven cases, were found to have prosthetic valve thrombosis. Target gradients on TTE were achieved for 71% (n=17) of mitral and 100% (n=3) of aortic valves: thrombolysis was successful in 74% (n=20), partial success in 18.5% (n=5) and unsuccessful in 7.4% (n=2) of cases. Subsequent complications were: myocardial infarction 7.4% (n=2), embolic phenomena 14.8 % (n=4), coronary emboli 7.4% (n=2), brain emboli 7.4% (n=2), re-thromboses 7.4% (n=2) and in-hospital mortality 7.4% (n=2) of cases. The mean time for follow-up after discharge was 3.04 ± 2.07 years; one patient died a year after discharge.

Thrombolytic therapy with streptokinase has been shown to be an effective and relatively safe method for managing prosthetic valve thrombosis.