Abstract
Background: Obstructive prosthetic valve thrombosis (PVT) is a life-threatening complication associated with acute heart failure and high mortality. Although surgery is the standard treatment, it may not be readily available in resource-limited settings. Low-dose, slow-infusion thrombolysis has emerged as a potential alternative.
Objective: To evaluate the feasibility, efficacy, and safety of low-dose, slow-infusion thrombolysis in patients with obstructive mechanical mitral valve thrombosis.
Methods: We conducted a case series of four patients treated between October 2020 and October 2022. Diagnosis was based on echocardiography and fluoroscopic assessment of leaflet motion. All patients received alteplase 50 mg administered intravenously over 6 hours without bolus, with repeat dosing as needed. Clinical and imaging responses were monitored using echocardiography, fluoroscopy, and coagulation parameters.
Results: Three patients required two thrombolytic cycles (total dose 100 mg), while one received a single 50 mg dose. Overall success was achieved in all patients, including complete success in three and partial success in one. One patient developed a transient ischemic attack; no major bleeding or mortality occurred. All patients had subtherapeutic INR at presentation.
Conclusion: Low-dose, slow-infusion thrombolysis appears to be a feasible, effective, and relatively safe treatment for obstructive PVT, particularly where surgical options are limited. Larger studies are warranted.
| Published | 2026-09-28 | |
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| Issue | Vol. 16 No. 5 (2026) | |
| Section | Case Reports | |
| DOI | 10.34071/jmp.2026.5.670 | |
| Keywords | huyết khối van cơ học, tiêu sợi huyết liều thấp, rt-PA |
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