Clinical and Applied Thrombosis/Hemostasis · Published 2026-01-01 · DOI 10.1177/10760296261417224
Background Thrombolysis remains a key treatment for mechanical left-sided valve thrombosis, but outcomes vary across agents and patient groups. We evaluated thrombolysis effectiveness and predictors of failure in a large single-center cohort. Methods We performed a retrospective cohort study of all patients with mechanical left heart valve thrombosis treated with thrombolysis at the Narayana Institute of Cardiac Sciences, Bangalore, from January 2013 to December 2023. Clinical, echocardiographic, and treatment data were obtained from the emergency registry and medical records. The primary outcome was successful thrombolysis, defined as complete restoration of valve function on echocardiography by hospital discharge without in-hospital complications. Logistic regression identified determinants of failure (p < 0.05 significant). Results We analyzed 190 patients (median age 43 years, IQR 36-52; 50% female). Bi-leaflet valves were present in 81.1%, and streptokinase was most frequently used (57.9%). Overall, 145 patients (76.3%) achieved successful thrombolysis, while 45 (23.7%) failed treatment. Major ischemic events occurred in 7.4%, hemorrhage in 1.6%, and 13 patients (6.8%) died. On multivariable analysis, failure was independently associated with female sex (aOR 2.59, 95% CI 1.13-5.92), double valve replacement (aOR 6.40, 95% CI 2.48-16.56), anemia (aOR 5.02, 95% CI 1.55-16.28), streptokinase use (aOR 3.05, 95% CI 1.11-8.33), and absence of fluoroscopy prior to therapy (aOR 3.77, 95% CI 1.59-8.95). Conclusion Thrombolysis achieved a 76.3% success rate, consistent with global reports. Tenecteplase showed greater success and fewer complications than streptokinase. Accounting for sex, valve type, anemia, and fluoroscopy may improve outcomes in mechanical valve thrombosis.
Abstract from DOAJ. Public domain (CC0 1.0).
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