What is the best treatment option for prosthetic valve thrombosis presenting with stroke?

What is the best treatment option for prosthetic valve thrombosis presenting with stroke?

In patients having prosthetic valve thrombosis presenting with stroke, surgery is the first option as thrombolysis is contraindicated. Surgical treatment has a combined risk of death or stroke of 9%.

For prosthetic valve thrombosis without stroke: 

If the thrombus in the prosthetic valve is less than 5 mm in size, only intravenous heparin is recommended. For larger thrombi there are two options: thrombolysis versus surgical treatment.

Thrombolysis has an initial success rate of 70 -80%, but there is a 5 -22% risk of embolism, and 5 -12% risk of disabling stroke. Thrombolysis is the preferred treatment for right sided prosthetic valve thrombosis and small left sided thrombi.