Tenecteplase infusion: The saviour in partially successful thrombolysis of prosthetic heart valve thrombosis

Abstract

A 20-year-old female, with history of mitral valve replacement presented with recent onset breathlessness. Cine fluoroscopy showed restricted leaflet mobility. Since she was in pulmonary oedema and there was no cardiothoracic surgery backup, she was immediately thrombolysed with tenecteplase 60 mg (1 mg/Kg) intra venous bolus. However, repeat cine revealed partially stuck leaflet and transesophageal echocardiography (TEE) showed thrombus measuring 0.35 cm2. Since symptoms persisted, we administered 0.25 mg/kg IV tenecteplase given over 6 hours. Slow thrombolysis with tenecteplase might be a safe and effective therapeutic strategy in patients with failed initial bolus thrombolytic therapy, especially in resource limited settings.

Keywords

• Prosthetic heart valve thrombosis
• Tenecteplase
• Thrombus