Completo y curioso caso el compartido por Sandeep Nathan, MD, MSc (@SandeepNathanMD).
Each time we get a thrombosed MVR (29 OnX) we scramble to recall lytic dosing. Regimen we just used (summarized fr recent pubs-thx @SajniPatel2!): 25mg tPA over 6hrs via PA catheter (no bolus), re-dosed q24hrs x2 (max 5x)=75 mg over 3d w TTEs q24hr. See pix below. #CardioTwitter pic.twitter.com/dkPjSkankt— Sandeep Nathan, MD, MSc (@SandeepNathanMD) September 10, 2019
Added bonuses of poor neck access & partly thrombosed iliac venous system required navigation w V18 wire & 4Fr, 135 cm Navicross which surprisingly stayed put in PA x 72 hrs. Gradient fr 25 to 7 w no embolization or bleeding. Valve fluoro pre- & post-75mg tPA+UFH anticoagulation. pic.twitter.com/UFov34itYU— Sandeep Nathan, MD, MSc (@SandeepNathanMD) September 10, 2019
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