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Recombinant tissue-type plasminogen activator (rt-PA) was administered intravenously to a 64-years old female with thrombotic malfunction of a Björk-Shiley prosthetic tricuspid valve. 150 mg of single-chain rt-PA was infused over 8 hours followed by an additional dose of 50 mg over the next 8 hours. At the end of the first infusion, restoration of normal valve function was demonstrated by fluoroscopic and echo-Doppler examinations. Mild systemic activation of the fibrinolytic system occurred, with a decrease of fibrinogen and alpha 2-antiplasmin to 53% and 33%, respectively, of the preinfusion value at the nadir.
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