RCT: Among patients with obstructive prosthetic heart valve thrombosis, tenecteplase achieved higher complete thrombolytic success (97.5%) than alteplase (81.5%) and a shorter hospital stay.

Question What is the safety and efficacy of a single bolus of intravenous tenecteplase as compared with a low-dose slow-infusion protocol of alteplase in patients with obstructive mechanical prosthetic heart valve thrombosis?

Findings In this randomized clinical trial including 83 patients, tenecteplase was found to have noninferior rates of complete thrombolytic therapy success compared with alteplase. There was no difference in adverse events between the 2 groups.

Meaning Study results show that a regimen of bolus-dose tenecteplase may be a safe and efficacious alternative to current therapy for patients with prosthetic heart valve thrombosis.