Comparison of tenecteplase and streptokinase in prosthetic mitral thrombosis: Tenecteplase as an alternative to surgery

摘要

Background: Management of prosthetic valve thrombosis (PVT)is either surgical or thrombolysis. For streptokinase (STK), successrate is variable. Only few studies have compared tenecteplase(TNK) with STK. Here we present data on use of TNK/STK in mitralPVT. Also, thrombolysis is emerging as a promising alternative tosurgery.Objectives: (a) Compare the use of TNK/STK in mitral PVT (b)Assessment of transvalvular gradients with echo in pre and postthrombolysis (c) analyze efficacy of TNK over surgery.Methods: Mitral PVT cases were given STK or TNK based onfinancial reasons and availability. Cases not willing for valve surgeryand those with contraindications to lysis were included.Streptokinase was given at a loading of 1.5–2.5 lac U, followedby 1 lac U/h for 12–24 h. TNK was given at bolus of 0.5 mg/kgIV. Thrombolysis was stopped if any major embolic or bleedingoccurs or in treatment failure. End outcome was divided into complete/partial success or failure. Patients with partial or no responsewere referred for surgery.