Thrombolysis by slow infusion of t-PA effective in prosthetic valve thrombosis: Study

Turkey: Low-dose and slow/ultraslow infusion of tissue plasminogen activator (t-PA) should be considered a viable treatment in patients with obstructive prosthetic valve thrombosis (PVT), concludes a recent study. In the study, published in the Journal of the American College of Cardiology, it was found that low-dose and slow/ultraslow infusion of t-PA was associated with low mortality and complications and high success rates. 

Prosthetic valve thrombosis is one of the life-threatening complications of prosthetic heart valve replacement. The optimal treatment of PVT remains controversial between surgery and thrombolytic therapy (TT) due to the lack of randomized controlled trials. To clarify this, Mehmet Ozkan, Ardahan University, Faculty of Health Sciences, Ardahan, Turkey, and colleagues aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT.

The study enrolled a total of 158 obstructive PVT patients (women: 103; median age 49 years) in the multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose t-PA (25 mg) mostly in repeated sessions. 3-month mortality following TT or surgery was the primary endpoint of the study.