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.
Based on the study, the researchers reported the following findings:
The initial management strategy was TT in 52.5% patients and surgery in 47.5% cases.
The success rate of TT was 90.4% with a median t-PA dose of 59 mg.
The incidences of outcomes in surgery and TT groups were as follows: minor complications (38.7%and 8.4% respectively), major complications (41.3% and 6% respectively), and the 3-month mortality rate (18.7% and 2.4% respectively).
The study demonstrates the successful use of TT in patients with obstructive PVT and suggests the effectiveness and relative safety of slow and/or ultraslow t-PA infusions.
Reference:
Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis: The Multicenter HATTUSHA Study. J Am Coll Cardiol 2022;79:977-989.
KEYWORDS: JACC, thrombolytic therapy, prosthetic valve thrombosis, tissue plasminogen activator, tPA, PVA, Mehmet Ozkan, surgery, thrombolysis, prosthetic heart valve replacement