What Is the Best Thrombolytic Strategy for Prosthetic Valve Thrombosis?

Thrombolysis is often the first-line treatment for prosthetic valve thrombosis (PVT). However, because PVT is relatively rare, thrombolytic dosing regimens have been based on those used for pulmonary embolism or acute myocardial infarction. In a longitudinal study at a single center in Turkey, investigators used transesophageal echocardiography to evaluate the safety and effectiveness of five thrombolytic dosing strategies in 182 patients with PVT (mean age, 43; 82% women):

1 –– 1993–1997 (16 episodes): streptokinase, 1.5 million units, 3-hour infusion, repeated once if needed

2 –– 1997–2001 (41 episodes): streptokinase, 1.5 million units, 24-hour infusion, repeated once if needed

3 –– 2001–2002 (12 episodes): tissue plasminogen activator (tPA…