What is a reasonable surveillance strategy and length of time to maintain patients with thrombosed bioprosthetic valves on systemic anticoagulation?

When a patient is clinically stable, CT scans and echocardiography can help in differentiating thrombus from pannus formation in bioprosthetic valves (though not perfectly). In the setting of significant symptoms or hemodynamic compromise, surgical valve replacement should be considered (transcatheter options can be considered in nonsurgical candidates) or thrombolytics. In the setting of asymptomatic to mild symptom progression, anticoagulation strategy (typically with coumadin or heparin products) can be attempted – typically for a minimum of 3-6 months with serial imaging and close clinical follow-up.