Comparative safety and efficacy of tenecteplase and streptokinase in prosthetic valve thrombosis: An observation from Eastern India

Prosthetic valve thrombosis (PVT) is a life-threatening emergency. Thrombolytic therapy is emerging as a potential substitute. The objective of this study was to assess the safety and efficacy of Tenecteplase (TNK) in comparison to streptokinase (STK) in patients with PVT. In this prospective study, patients with PVT who were not subjected to the surgery underwent thrombolysis with TNK (TNK arm) or STK (STK arm). Efficacy and safety of both treatment arms were judged from clinical, echocardiographic (ECHO), and Cinefluoroscopic parameters. Treatment outcomes and complications were compared between the two arms.Between December 2017 and December 2019, a total of 41 cases of PVT were enrolled to receive either TNK (n=23) or STK (n=18). After thrombolysis, complete recovery was significant in the TNK arm (82.6% [19/23] vs. 44.4% [8/18], respectively; p=0.007) irrespective of the valve position. This trend was observed in both mitral PVT (85.7% vs. 46.6%, respectively; p=0.03) and aortic PVT (77.8% vs. 33.3%, respectively; p=0.151). No failure was seen in the TNK arm but failure was observed in 1/3cases in the STK arm. No major bleeding was observed with either treatment. Minor bleeding and systemic embolization were non-significant (P=0.514). There were no deaths in the TNK arm but two patients (11%) from the STK arm died.To our knowledge, this is the largest published comparative evidence indicating superior efficacy and equal safety of tenecteplase compared to streptokinase for the treatment of prosthetic valve thrombosis irrespective of valve position and NYHA class.