How to perform and manage low-dose and slow/ultra-slow tissue type plasminogen activator infusion regimens in patients with prosthetic valve thrombosis

Abstract

Over the last two decades, thrombolytic therapy (TT) has become an alternative to surgery as a first-line therapy in patients with thrombosed mechanical valves [1, 2, 3]. In TROIA Trial, low dose (25 mg)—slow infusion (6 h) of tissue type plasminogen activator (t-PA) has been found to be an effective and safe regimen in the management of prosthetic valve thrombosis (PVT) [4]. Accelerated and high dose TT regimens were associated with higher complication and mortality rates. 2014 AHA/ACC guideline for the management of patients with valvular heart disease had recommended emergency surgery for patients with left-sided PVT with NYHA Class III-IV (Class 1-B) and large, mobile thrombus(> 0.8 cm2) (Class 2a).