Successful Thrombolytic Therapy for Mechanical Mitral Valve Thrombosis Using Bivalirudin-Based Thrombolytic Regimen

Distinguishing the cause of a mechanical valve obstruction as a thrombus or a pannus can be difficult but is critical because pannus can be treated only with surgical valve replacement and thrombus can be treated with surgery or fibrinolytic therapy. This case report describes a patient with a mechanical valve thrombosis and reported allergy to porcine products who was treated by an unusual regimen: ultraslow-infusion, low-dose fibrinolytic therapy with administration of bivalirudin as a bridging anticoagulant.