AIMS: To find the incidence, risk factors of Prosthetic Valve Thrombosis (PVT)To study the efficacy, outcome and complications of fibrinolysis in PVT. METHODS: Data from 44 consecutive patients admitted with PVT treated with fibrinolytics were assessed, outcomes recorded. Only medically managed PVT were included in this study and Surgical management were not included due to inadequate resources. RESULTS: Out of 44 patients, 28 were female and 16 were male with mean age of 36.5 41 had underwent MVR, 3 had underwent DVR. 42 (92.4 %) had thrombus at mitral valve 2 (4.5 %) were at aortic valve. Visible clot was present in 7 (15.9 %) and absent in 37 (84 %) patients. 7 (15.9 %) had recurrent episode of PVT. At the time of thrombolysis, no patient had major bleeding manifestation. During follow up after thrombolysis, 37 (84 %) were alive and 7 (16 %) expired. The incidence of primary end point i.e successful thrombolysis (as defined as complete response without complications) was seen in 61.3 % patients. The secondary end point i.e. Therapeutic failure/death is recorded in 15.9 % study subjects. Among the vulnerable population, therapeutic Failure/death is seen with 57.1 % sub-therapeutic anticoagulant consumers and 42.8 % patients with poor drug compliance. CONCLUSION: In conclusion this study sheds light on the complexities and challenges associated with prosthetic valve thrombosis in pregnant patients, patients with sub therapeutic anticoagulation or poor drug consumers. This study underscores the importance of close monitoring, optimal anticoagulation, patient education. This study highlights that fibrinolysis unless contraindicated can be considered as effective especially in developing countries or in centres with limited resources, where multiple factors such as surgical availability, financial cost, high operative mortality are to be weighed before treatment.