FATAL CEREBRAL-HEMORRHAGE COMPLICATING THROMBOEMBOLIC STROKE IN A PATIENT WITH PROSTHETIC MITRAL-VALVE THROMBOSIS TREATED WITH THROMBOLYTICTHERAPY

We report the case of a 66-year-old male with a history of mitral valv e replacement with a Sorin tilting-disk prosthesis and a subsequent op eration for severe constrictive pericarditis. After 5 years of stable anticoagulant treatment, he suffered an intracerebral hemorrhage that required temporary withdrawal of warfarin. Thrombosis of the prosthesi s, presenting as acute heart failure, was then determined. Due to high -operative and hemorrhagic risk, the patient was treated with low-dose thrombolytic therapy administered as two boluses of recombinant tissu e plasminogen activator (r-tPA). The patient's hemodynamics improved s trikingly. However, a few hours after the second dose, a devastating c erebral hemorrhagic infarction resulted in death. Autopsy showed the p rimarily ischemic nature of both strokes. The schemes of thrombolytic therapy in prosthetic heart valve thrombosis and the importance of a c orrect interpretation of pathogenesis of stroke in anticoagulated pati ents are discussed.