Treatment of Recurrent Prosthetic Mitral Valve Thrombosis with Reteplase: A Report of Four Cases

Thrombosis is a life threatening complications of prosthetic mitral valves and is associated with high morbidity and mortality. Even in presence of systemic anticoagulation prosthetic valve thrombosis has an incidence of 0.5% to 8%. Recurrent prosthetic valve thrombosis and the resulting thrombotic occlusion require re-establishment of blood flow across the valve. While surgical repair is considered the classic first line treatment option for prosthetic valve thrombosis, intravenous thrombolysis has emerged as an acceptable alternative for the first episode of prosthetic valve thrombosis. Due to the limitation of using streptokinase in recurrent thrombotic events, fibrin-specific tissue plasminogen activators have been successfully utilized to treat cases of recurrent prosthetic valve thrombosis. In this case-series, we have reported four cases of recurrent prosthetic valve thrombosis that were successfully treated with Reteplase at our hospital.