Thrombolysis - Uses, Types, Advantages, and Complications

Introduction

Blood clots can be dangerous. They can be a major cause of heart attack and brain stroke. Pulmonary thromboembolism (blood flow is blocked in the lungs) can occur if a dangerous blood clot breaks free in the leg and travels to the lungs. Thrombolysis, also known as thrombolytic therapy, makes use of medicines or a minimally invasive surgical procedure to destroy blood clots and prevent the formation of new clots.

What Is Thrombolysis?

Thrombolysis, also known as fibrinolytic therapy, is a treatment that involves the breakdown of dangerous blood clots in blood vessels. It also helps to improve vascular flow and prevent tissue and organ damage. This technique injects clot-dissolving drugs intravenously or through a long catheter to deliver the medicines to the blockage site. It may also involve mechanically removing the clot or physically breaking it up.

Thrombolysis is often considered an emergency treatment to dissolve the arterial blood clots in the heart and brain (these clots are the main cause of heart attacks, ischemic strokes, and acute pulmonary embolisms).

What Are the Uses of Thrombolysis?

• Used to treat patients with heart attacks, strokes, and pulmonary thromboembolism who have clot formation in the arteries.

• Use to remove clots from the veins that cause deep vein thrombosis (clot formation in the veins) in the upper and lower extremities (mainly legs) and pelvic region. If the condition is left untreated, pieces of the blood clot can break off and travel to a pulmonary artery in the lungs, leading to an acute pulmonary embolism.

• Coronary artery bypass grafts (bypass graft surgery is used to create a new path for blood to flow around a blocked coronary artery in the heart).

• Hemodialysis catheters (a catheter that is used to exchange blood between a dialysis machine and a patient).

If the blood clot is dangerous and life-threatening, thrombolysis may be considered an option if initiated within one to two hours after the onset of symptoms of angina, ischemic stroke, or other diseases.

What Are the Types of Thrombolysis?

Usually, there are three types of thrombolysis:

• Systemic Thrombolysis: The medications are delivered through an intravenous line into the bloodstream. It is often used as an emergency treatment procedure for serious conditions like heart attack, pulmonary embolism, and stroke.

• Catheter-Directed Thrombolysis: This technique makes use of a long catheter to deliver the drug directly into the blood clot. It is most often used as a treatment procedure to treat deep vein thrombosis and peripheral arterial diseases.

• Mechanical Thrombectomy: In this procedure, a long catheter with an ultrasound device, a rotating suction cup, or a fluid jet is used to break the blood clot or suction it. It is sometimes used along with catheter-directed thrombolysis.

What Are the Commonly Used Thrombolytic Agents?

The most commonly used clot-dissolving drugs that are also known as thrombolytic agents include:

• Eminase.

• Retavase.

• Streptase (streptokinase).

• Tissue plasminogen activator (tPA)

• Tenecteplase (TNKase).

• Urokinase.

What Kind of Drug Is Thrombolytics?

Thrombolytics are fibrinolytic drugs. They are also known as clot-busting drugs because they help to break and dissolve the blood clots that come in the way of the blood flow. These drugs are basically enzymes that catalyze the process of protein (fibrin) breakdown that are responsible for clot formation.

Who Should Not Be Given Thrombolysis?

Healthcare providers do not recommend fibrinolytic therapy if the patient is suffering from conditions associated with a higher risk of bleeding, such as:

• Active bleeding.

• Recent intracranial hemorrhage.

• Recent brain or spine surgery.

• Hypertension.

• Kidney failure.

• Traumatic brain injury.

• Pregnant women.

• Elderly people with an increased risk of complications.

What Are the Advantages of Thrombolysis?

Thrombolysis usually breaks down the blood clots which if left untreated, may cause:

• Disability in the patients.

• Loss of limbs.

• Death of the patient.

What Are the Complications of Thrombolysis?

The main risk of thrombolysis is internal bleeding. Approximately four to five percent of people who have undergone thrombolysis therapy suffer from major internal bleeding and almost about one percent may suffer from brain bleeds that may lead to a stroke. Other risks and complications include:

• Intracranial bleeding.

• Allergic reactions.

• Nasal bleeding.

• Hematuria (bleeding in the urine).

• Hemorrhoids (bleeding from stools).

• Blood loss at the site of the catheter or intravenous line insertion.

• Damage to the blood vessels.

• Kidney damage especially in diabetic patients.

• Low blood pressure.

• The blood clot may travel to another part of the body.

• Swollen tissues.

• Abnormal heart rhythms (ventricular arrhythmias).

• Risk of developing infection.

What Is the Recovery Time After Thrombolysis?

After receiving thrombolytic agents, usually it takes about:

• A minimum of one day in the intensive care unit (ICU).

• The patient should spend around one to three days in the hospital under observation to ensure that the clots have been dissolved.

What Is the Prognosis After Thrombolysis?

Thrombolysis is usually successful in dissolving blood clots. However, up to 25 % of people still have a blood clot even after fibrinolytic therapy. Some people may develop a blood clot or a blockage in the blood vessels again. In such cases, the healthcare provider usually suggests another type of surgery that is minimally invasive to eliminate the underlying pathology of the blood clot.

Conclusion

Thrombolysis (thrombolytic or fibrinolytic therapy) uses medications (thrombolytic agents) to break down blood clots. This emergency procedure is used by healthcare providers to treat emergency situations such as heart attack, pulmonary embolism, and ischemic stroke. Thrombolytic therapy is also used to treat blood clots that are caused due to deep vein thrombosis (DVT) or peripheral artery disease (PAD). In this procedure, an intravenous line or a catheter is inserted for dissolving the blood clots. This technique can usually take from one hour to approximately 48 hours for the procedure to complete. However, there are certain risks associated with thrombolytic therapy that include intracranial bleeding and low blood pressure (hypotension). The outlook of the technique is good in some patients. But in other patients, additional surgery may be required by the healthcare provider to eliminate the underlying cause of the disease because of the formation of blood clots again.