Successful Reversal of Late, Severe Thrombotic Bioprosthetic Mitral Valve Stenosis With Anticoagulation Therapy.

Late bioprosthetic valve thrombosis (bPVT) is a rare and potentially life-threatening complication following valve replacement with thrombus formation leading mostly to valvular stenosis or embolic phenomena. Clinically, it manifests as symptoms of fatigue, dyspnea, or reduced exercise capacity. The existing treatment guidelines lack clear recommendations for managing this specific presentation. In this case study, we present a distinct clinical scenario wherein the use of anticoagulation, specifically apixaban, successfully reversed very late, severe thrombotic stenosis in a 78-year-old woman with a Medtronic Hancock II porcine mitral valve (Dublin, Ireland). This case highlights the need to consider bPVT as an alternative etiology to valve degeneration in the setting of late bioprosthetic valve stenosis. Additionally, it demonstrates how apixaban therapy may serve as a viable treatment modality in these scenarios.