Thrombolytic therapy in prosthetic valve thrombosis in the second trimester of pregnancy

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Pregnancy with mechanical valves requires anticoagulation, the risk of bleeding and embryopathy associated with oral anticoagulation must be weighed against the risk of valve thrombosis. In the presence of a mechanical valve thrombosis, an appropriate treatment modality must be selected. Prosthetic valve thrombosis during pregnancy requires immediate therapy such as valve replacement, thrombolytic therapy, or surgical thrombectomy. A course of thrombolytic therapy may be considered as a first-line therapy for prosthetic heart valve thrombosis. We describe a primigravida (second trimester) with mitral valve replacement status presenting with acute prosthetic valve thrombosis and treated successfully with intravenous streptokinase.