Question 1

1)  What is Thrombolysis?

Accepted Answer

Thrombolysis is a treatment done to dissolve dangerous blood clots in the blood vessels, improving the flow of blood, and preventing damage to the organs and tissues.

Question 2

2) What are the different types of Thrombolysis?

Accepted Answer

The different types of thrombolysis include:

Catheter-based thrombolysis: The doctor makes a cut or incision in the groin area and inserts a catheter. The catheter is guided to the site of a blood clot, and some special instruments are used or medications are injected to break up the blood clot.
Intravenous thrombolysis: A medication is injected through an IV, that is, directly into the vein of a person. This medicine goes to the blood clot site to break it up or dissolve it.

Question 3

3) What are the commonly used Thrombolytic agents?

Accepted Answer

The most commonly used thrombolytic agents include:

Retavase
Eminase
TNKase
Streptase
t-PA
Abbokinase
Kinlytic

Question 4

4) What is Thrombolysis performed?

Accepted Answer

Thrombolysis is performed for the treatment of the following:

Blood clots in the peripheral arteries (arteries supplying blood to the legs and arms)
Blood clots in the catheters (a thin, flexible tube), like dialysis catheters (used for the exchange of blood between the patient and hemodialysis machine) and central venous catheters (a catheter is placed in the large vein above the heart)
Bypass grafts (a procedure involving the redirection of blood around a blocked artery in the heart)
Heart attack, due to a blood clot in the artery supplying the heart muscle
Deep vein thrombosis, which is a blood clot formation in the leg or pelvis area
Pulmonary embolism, which is a blockage of the lung artery by a blood clot
Stroke, due to the development of a blood clot in the brain artery

Question 5

5) What are the symptoms seen in people having blood clots and requiring Thrombolysis?

Accepted Answer

Depending on where the blood clot is present, the symptoms vary. The following symptoms are associated with blood clots present in different locations:

1. Heart attack due to a clot in the coronary (heart) arteries:

Nausea
Sweating
Breathlessness

2. Deep vein thrombosis (DVT):
Swelling, pain, or redness in the veins of the legs or pelvis area

3.Blood clot in the arteries of the intestines:

Blood in stools
Stomach pain

4. Clot in the brain:

One side of the body may become weak
Loss of vision
Loss of speech

5. Pulmonary embolism:

Shortness of breath
Chest pain
Rapid breathing

6. Shock:

Cold, clammy skin
Increase in pulse rate
Bluish tinge to the lips or fingernails
Enlarged pupils
Nausea
Vomiting
Weakness
Rapid breathing

Question 6

6) When should Thrombolysis be avoided?

Accepted Answer

Thrombolysis is contraindicated in the following cases:

A recent trauma or injury of the head
Bleeding disorders
Bleeding ulcers
Pregnancy
A recent surgery
High blood pressure
If you are on blood-thinning medications
Kidney diseases

Question 7

7) What is the diagnostic procedure before Thrombolysis?

Accepted Answer

The patient is first examined by the doctor physically to check for the symptoms. The following diagnostic tests may be recommended before thrombolysis:

Echocardiogram: Sound waves are used to create clear images of the heart.
Angiogram: A dye is injected through a catheter and x-rays are taken to detect blockages in the blood vessels.
Carotid duplex ultrasound: The blood flow in the arteries supplying blood to the brain is assessed using a traditional ultrasound and Doppler ultrasound.
CT scans and MRI scans: These are imaging tests done to obtain clear images of the heart and blood vessels.

Question 8

8) How to prepare for Thrombolysis?

Accepted Answer

The following preparation may be required for a thrombolysis procedure:

The doctor should be informed if you are taking any medications, supplements, or herbs.
Inform your doctor in case of any pre-existing medical conditions that you may be having.
If you are allergic to any medicines, anesthetic agents, tape, latex, or iodine, tell your doctor about the same.
If you are pregnant or you suspect a pregnancy, inform the doctor about the same.
You may be asked to stop blood-thinning medications like warfarin and aspirin a few days prior to the procedure.
Follow the instructions given by your doctor regarding the diet and medications that can be taken before the procedure.

Question 9

9) What is the procedure for Thrombolysis?

Accepted Answer

The procedure of thrombolysis varies depending on the type and site of blood clot present, and whether it is being performed as an emergency or a pre-planned procedure.

An IV is inserted into the patient.
A clot-busting medication is injected through the IV for intravenous thrombolysis. This medicine travels to the blood clot site and dissolves it.
In the case of catheter-based thrombolysis, the area in the groin region is first cleaned and shaved. Sometimes, the elbow may be used as the site for the procedure.
The groin area is covered using sterile drapes.
Painless electrodes are placed on the chest region.
These electrodes are attached to an electrocardiogram (ECG) machine to measure the electrical activity of the heart.
The groin area is numbed using local anesthesia.
The patient may be given a sedative to help him/her relax.
An incision is made in the groin region.
A catheter is inserted and guided to the site of the blood clot.
Clot-busting medications or special instruments are then used to break up the clot.
The catheter, electrodes, and IV line are removed after the completion of the procedure.
You will be required to lie flat for approximately six hours after the procedure.

Question 10

10) How to care after Thrombolysis?

Accepted Answer

Normally, a person can go home on the same day of intravenous thrombolytic treatment if there are no other medical disorders.
For a catheter-based thrombolytic treatment, the patient needs to stay in the hospital for a few days after the procedure.
The doctor may do some imaging tests to confirm the dissolution of the blood clot.
It is normal to have some discomfort at the groin or elbow region after catheter-based thrombolysis.
Some bleeding may be noticed after the procedure.

The doctor may prescribe some painkillers to control the pain and discomfort of the patient.
Consult the doctor if any of the following symptoms are noticed following a thrombolytic therapy:

Excessive bleeding
Back pain
Chest pain
Blood in urine
Blood in stools
Color changes in the extremities
Changes in sensations or temperature in the extremities
Fever
Nausea
Dizziness
Shortness of breath
Pain, swelling, or redness around the incision area
Worsening of pain in the extremities

The doctor may recommend blood-thinning medications to be taken after the procedure.
In case of a recurrent blood clot, or a clot that has not dissolved completely, other treatment modalities may be required.

Question 11

11) Who can do a Thrombolysis procedure?

Accepted Answer

Depending on the site of the blood clot, the following doctors can perform thrombolytic therapy:

Cardiologists
Neuroradiologists
Neurosurgeons
Vascular surgeons
Vascular and interventional radiologists
Pulmonologists
Thoracic surgeons
Critical care medicine doctors

Question 12

12) What are the risks of Thrombolysis?

Accepted Answer

Some of the complications associated with thrombolysis include:

Allergic reaction to contrast dye
Bruising at the access site
Bleeding at the access site
Damage to the blood vessels
Blood clot migrates to another part of the vascular system
Bleeding in the brain
Kidney damage
Stroke (the blood supply to the brain is interrupted)

Thrombolysis

Symptoms

Diagnosis

Treatment

Risks

After Procedure

Thrombolysis from one of the best multi-speciality hospital: Manipal Hospital Bhubaneswar, Jayadev Vatika Park, Bhubaneswar

Dr. Mahesh Prasad Agrawala

Dr. Jajati Keshari Padhi

Dr. Pradeep Kumar Dash

Dr. Dibya Ranjan Behera

Dr. Milan Kumar Ghadei