Mechanical valve thrombosis is a life-threatening complication, occurring in 0.5% to 8% of left-sided mechanical prosthetic valves, and in 20% of tricuspid valve prostheses. Although surgery is the first-line treatment modality particularly in symptomatic obstructive mechanical valve thrombosis, it is associated with high rates of morbidity and mortality. Fibrinolytic therapy and thrombolytic therapy have also been used as an alternative to surgical treatment. The risk for cerebral thromboembolism associated with thrombolytic therapy seems to be the main limitation for its use in left-sided mechanical valve thrombosis. In this article, we reviewed the treatment alternatives in obstructive mechanical valve thrombosis in the light of relevant studies, with a brief presentation of our experience.