Prosthetic valve thrombosis with stroke – Cardiology MCQ

a) Thrombolysis

b) Intravenous heparin

c) Subcutaneous heparin

d) Surgery

In patients presenting with stroke, surgery is the first option as thrombolysis is contraindicated. Surgical treatment has a combined risk of death or stroke of 9%.

For prosthetic valve thrombosis without stroke: 
If the thrombus in the prosthetic valve is less than 5 mm in size, only intravenous heparin is recommended. For larger thrombi there are two options: thrombolysis versus surgical treatment.

Thrombolysis has an initial success rate of 70 -80%, but there is a 5 -22% risk of embolism, and 5 -12% risk of disabling stroke. Thrombolysis is the preferred treatment for right sided prosthetic valve thrombosis and  small left sided thrombi.