Management of acute ischemic stroke occurred during thrombolytic treatment of a patient with prosthetic mitral valve thrombosis: continuing thrombolysis on top of thrombolysis.

Prosthetic heart valve thrombosis (PHVT) is one of the major causes of primary valve failure. Even with the use of warfarin, risk of thromboembolism is 1-2% per year, but the risk is considerably higher without or inadequate treatment with warfarin (1). Although surgery is the first-line treatment modality in symptomatic PHVT (2), thrombolytic therapy has recently evolved as an effective substitute to surgery (3-6). Cerebral thromboembolism associated with thrombolytic therapy of left-sided PHVT seems to be the main limitation. Acute ischemic stroke may be managed with thrombolysis in selected cases (7, 8).