Time to Thrombolysis and Outcomes in Patients with Left-sided Prosthetic Valve Thrombosis: Is Thrombolysis Worth Beyond 7 Days?

Abstract

Background: The study aimed to evaluate the clinical outcome and complications after thrombolysis in patients with left-sided prosthetic valve thrombosis (PVT) in relation to the time of onset of symptoms.

Materials and methods: This was a prospective, observational, single-center study carried out from January 2020 to June 2022 at a tertiary care center in India. A total of 50 patients with PVT were included in the study. Patients underwent thrombolysis either with streptokinase or tenecteplase as per their individual clinical status. Clinical profile and treatment outcomes were assessed.

Results: PVT was more in females (64%) as compared to males (36%). The majority of the patients were in the age group of 31-40 years (38%) with a mean age of presentation being 32.7 years. Majority of the patients (39 patients) had symptom onset between 0 and 7 days (78%) while 11 patients (22%) presented beyond 7 days. Streptokinase was used for thrombolysis in 37 patients while Tenecteplase was used in 13 patients. In our study, majority of the patients 30 (60%) had a complete response to thrombolysis while 10 (20%) patients had a partial response, and no response to thrombolysis was seen in 10 (20%) patients. Hemorrhagic stroke was seen in 4 (8%) patients. Among 6 deaths, 3 were due to hemorrhagic stroke and 3 were due to cardiogenic shock.

Conclusions: Early thrombolysis within 7 days of symptom onset provides a good response to thrombolysis after which the response to thrombolysis is more likely to be suboptimal.