Is thrombolysis really still controversial?
• Jose Santos-Gracia, MD, PhD • Fidel Manuel Caceres-Loriga National Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba Dear Editor, We have read with great interest the article by Roudaut et al entitled “Thrombosis of prosthetic heart valves: Diagnosis and therapeutic considerations” published in the last issue of your journal.(1) According to the authors, the first therapeutic consideration in obstructive left-sided prosthetic valve thrombosis (PVT) should be surgery and thrombolysis should be reserved for patients with contraindications to surgery. The Consensus Conference recommended surgical treatment for critically unstable patients (NYHA class III-IV) and thrombolysis for those with high surgical risk or clear contraindications to surgery. In hemodynamically stable patients (NYHA class I-II) full anticoagulation with heparin has been the recommended treatment. (2) However, more recent data have shown that thrombolysis is superior to surgery in the most critical
