title: Low-Dose Alteplase Infusion for the Treatment of Mechanical Aortic Valve Thrombosis: A Spotlight on the Importance of Medication Adherence.
abstract: A rare, yet serious, complication of mechanical heart valves is symptomatic obstructive prosthetic valve thrombosis. The risk of valve thrombosis is magnified in patients who are nonadherent to prescribed anticoagulation. In this case report, we describe a 48-year-old male patient with a history of mechanical aortic valve replacement surgery, who stopped taking prescribed warfarin therapy 2 years before presentation and subsequently developed acute decompensated heart failure secondary to valvular dysfunction. Low-dose alteplase therapy was administered successfully with no bleeding complications and a complete return of valvular function.
authors.affiliation: Manuel Isherwood, PharmD PGY-1 Pharmacy Practice Resident, Atlantic Health System, Morristown, New Jersey.Michael Serra, PharmD Clinical Pharmacist, Cardiology, Atlantic Health System, Morristown, New Jersey.Jordan Safirstein, MD Interventional Cardiologist, Atlantic Health System, Morristown, New Jersey.Neel Shah, MD Cardiology Fellow (3rd Year), Atlantic Health System, Morristown, New Jersey.Mark Rosenthal, MD Attending Cardiologist and Cardiology Fellowship Director, Atlantic Health System, Morristown, New Jersey.
authors.forename: Manuel
authors.initials: M
authors.lastname: Isherwood
authors.forename: Michael
authors.initials: M
authors.lastname: Serra
authors.forename: Jordan
authors.initials: J
authors.lastname: Safirstein
authors.forename: Neel
authors.initials: N
authors.lastname: Shah
authors.forename: Mark
authors.initials: M
authors.lastname: Rosenthal
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator