Thrombolysis

Thrombolysis or thrombolytic therapy is a type of treatment for a blood clot formed inside a blood vessel.

Medications are used to dissolve or break up the blood clot. The blood clots can grow, break loose, and cut off the blood supply to the tissues and organs. This can lead to complications like heart attack and stroke (a condition in which the blood supply to the brain is stopped).
Thrombolysis can be performed as a pre-planned procedure or emergency procedure. Although it is a minor procedure, it may still have some complications.

Types: The different types of thrombolysis are:
1. Catheter-based thrombolysis: It involves making an incision in the groin region through which the doctor will insert a long, flexible, thin tube known as a catheter. The doctor will guide the catheter to the site of the blood clot and inject certain medications or use some special instruments for breaking up the clot.
2. Intravenous thrombolysis: This procedure involves injecting certain medications through an IV. This medicine travels to the clot site and dissolves it or breaks it up.
The commonly used clot-busting drugs or thrombolytic agents include:

  • Eminase
  • Streptase
  • Retavase
  • TNKase
  • t-PA
  • Abbokinase
  • Kinlytic, Abbokinase
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Purpose: Thrombolysis is used for the following types of treatment:

  • Blood clot formation in grafts or catheters
  • Blood clot formation in the peripheral arteries (arteries supplying blood to the arms and legs)
  • Heart attack due to the formation of a blood clot in the artery supplying the heart muscle
  • Deep vein thrombosis, which is a blood clot that develops in a vein in the pelvis or legs.
  • Pulmonary embolism, which is a blood clot that lodges in a lung artery.
  • Ischemic stroke, which occurs when a blood clot develops or lodges in a brain artery.

Symptoms:
The symptoms of thrombolysis vary depending on the site of the blood clot. Some of the symptoms of different types of blood clots are:
1. Pulmonary embolism:

  • Shortness of breath
  • Rapid breathing
  • Pain in the chest

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

  • Breathlessness
  • Nausea
  • Sweating

3. Deep vein thrombosis (DVT):

  • Swelling in the veins
  • Pain in the veins
  • Redness in the veins

4. Blood clot in the arteries of the intestines:

  • Bloody stool
  • Abdominal pain

5. Clot in the brain:

  • Weakness in one side of the body
  • Loss of speech
  • Loss of vision

6. Shock:

  • Pale and cold skin
  • Rapid pulse
  • Rapid breathing
  • Bluish tinge to the lips or fingernails
  • Enlarged pupils
  • Nausea
  • Vomiting
  • Weakness
  1. Physical examination: The patient is examined to check for symptoms that could require thrombolysis.
  2. Angiography: A special x-ray that is taken by injecting a special dye through a catheter is known as an angiogram. It is used for detecting the presence of blockages or aneurysms (ballooning of the blood vessel walls) in the blood vessels.
  3. Computerized tomography (CT) scan and magnetic resonance imaging (MRI) scan: These are imaging tests done to obtain clear images of the heart and blood vessels.
  4. Echocardiogram: Sound waves are used to obtain images of the heart in this test.
  5. Carotid duplex ultrasound: The flow of blood in the arteries supplying blood to the brain is assessed by using a combination of traditional ultrasound and Doppler ultrasound.

 

An intravenous line or catheter may be used depending on the type of clot that needs to be treated. 
  • Systemic thrombolysis- in systemic thrombolysis, clot-busting medications or drugs are administered with the help of an IV (intravenous) line through a vein usually in the arm. The drug circulates in the blood stream and eventually reaches the clot. It is used for pulmonary embolisms, heart attacks and strokes.
  • Catheter-directed thrombolysis- in catheter directed thrombolysis, a catheter (small plastic tube) is inserted into the body through a vein. The catheter is used to administer medicine directly into the clot. 
  • Mechanical thrombectomy- this is used to physically break or suck the clot out of the body with the help of a small machine that is attached to one end of the catheter.
Heart and lung function is monitored closely during the procedure. The position of the clot is determined with the help of X-rays and other imaging techniques. The patient may be lightly sedated. The clot could dissolve within 24 hours, but in some cases, it may take upto 72 hours for the clot to dissolve.

The complications of thrombolysis are:

  • Allergic reaction to contrast dye
  • Bleeding or bruising at the site of access
  • Blood vessel damage
  • Kidney damage, especially in cases of pre-existing kidney disease or diabetes
  • Blood clot migration to another part of the vascular system
  • Bleeding in the brain
  • Stroke
  • In the case of a person with no underlying medical condition, the patient can go home on the same day of intravenous thrombolytic treatment.
  • In the case of a catheter-based thrombolytic treatment, you are likely to stay in the hospital for some days.
  • Some imaging tests may be performed for confirming the dissolution of the blood clot.
  • It is normal to have some pain and discomfort at the groin or elbow region after catheter-based thrombolysis.
  • It is normal to have some bleeding after the procedure, which may include bleeding from the nose and gums.
  • Some painkillers may be recommended 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
  • Color changes in the extremities
  • Changes in sensations or temperature in the extremities
  • Blood in urine 
  • Blood in stools
  • Fever
  • Nausea
  • Dizziness
  • Shortness of breath
  • Pain, swelling, or redness around the incision area
  • Worsening of pain in the extremities

You may be asked to take blood-thinning medications after the procedure.
In case of a blood clot that recurs, or has not dissolved completely, other treatment procedures may be required.

 

Thrombolysis Cost in Chennai

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Thrombolysis

Thrombolysis or thrombolytic therapy is a type of treatment for a blood clot formed inside a blood vessel.

Medications are used to dissolve or break up the blood clot. The blood clots can grow, break loose, and cut off the blood supply to the tissues and organs. This can lead to complications like heart attack and stroke (a condition in which the blood supply to the brain is stopped).
Thrombolysis can be performed as a pre-planned procedure or emergency procedure. Although it is a minor procedure, it may still have some complications.

Types: The different types of thrombolysis are:
1. Catheter-based thrombolysis: It involves making an incision in the groin region through which the doctor will insert a long, flexible, thin tube known as a catheter. The doctor will guide the catheter to the site of the blood clot and inject certain medications or use some special instruments for breaking up the clot.
2. Intravenous thrombolysis: This procedure involves injecting certain medications through an IV. This medicine travels to the clot site and dissolves it or breaks it up.
The commonly used clot-busting drugs or thrombolytic agents include:

  • Eminase
  • Streptase
  • Retavase
  • TNKase
  • t-PA
  • Abbokinase
  • Kinlytic, Abbokinase

Symptoms

Purpose: Thrombolysis is used for the following types of treatment:

  • Blood clot formation in grafts or catheters
  • Blood clot formation in the peripheral arteries (arteries supplying blood to the arms and legs)
  • Heart attack due to the formation of a blood clot in the artery supplying the heart muscle
  • Deep vein thrombosis, which is a blood clot that develops in a vein in the pelvis or legs.
  • Pulmonary embolism, which is a blood clot that lodges in a lung artery.
  • Ischemic stroke, which occurs when a blood clot develops or lodges in a brain artery.

Symptoms:
The symptoms of thrombolysis vary depending on the site of the blood clot. Some of the symptoms of different types of blood clots are:
1. Pulmonary embolism:

  • Shortness of breath
  • Rapid breathing
  • Pain in the chest

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

  • Breathlessness
  • Nausea
  • Sweating

3. Deep vein thrombosis (DVT):

  • Swelling in the veins
  • Pain in the veins
  • Redness in the veins

4. Blood clot in the arteries of the intestines:

  • Bloody stool
  • Abdominal pain

5. Clot in the brain:

  • Weakness in one side of the body
  • Loss of speech
  • Loss of vision

6. Shock:

  • Pale and cold skin
  • Rapid pulse
  • Rapid breathing
  • Bluish tinge to the lips or fingernails
  • Enlarged pupils
  • Nausea
  • Vomiting
  • Weakness

Diagnosis

  1. Physical examination: The patient is examined to check for symptoms that could require thrombolysis.
  2. Angiography: A special x-ray that is taken by injecting a special dye through a catheter is known as an angiogram. It is used for detecting the presence of blockages or aneurysms (ballooning of the blood vessel walls) in the blood vessels.
  3. Computerized tomography (CT) scan and magnetic resonance imaging (MRI) scan: These are imaging tests done to obtain clear images of the heart and blood vessels.
  4. Echocardiogram: Sound waves are used to obtain images of the heart in this test.
  5. Carotid duplex ultrasound: The flow of blood in the arteries supplying blood to the brain is assessed by using a combination of traditional ultrasound and Doppler ultrasound.

 

Treatment

An intravenous line or catheter may be used depending on the type of clot that needs to be treated. 
  • Systemic thrombolysis- in systemic thrombolysis, clot-busting medications or drugs are administered with the help of an IV (intravenous) line through a vein usually in the arm. The drug circulates in the blood stream and eventually reaches the clot. It is used for pulmonary embolisms, heart attacks and strokes.
  • Catheter-directed thrombolysis- in catheter directed thrombolysis, a catheter (small plastic tube) is inserted into the body through a vein. The catheter is used to administer medicine directly into the clot. 
  • Mechanical thrombectomy- this is used to physically break or suck the clot out of the body with the help of a small machine that is attached to one end of the catheter.
Heart and lung function is monitored closely during the procedure. The position of the clot is determined with the help of X-rays and other imaging techniques. The patient may be lightly sedated. The clot could dissolve within 24 hours, but in some cases, it may take upto 72 hours for the clot to dissolve.

Risks

The complications of thrombolysis are:

  • Allergic reaction to contrast dye
  • Bleeding or bruising at the site of access
  • Blood vessel damage
  • Kidney damage, especially in cases of pre-existing kidney disease or diabetes
  • Blood clot migration to another part of the vascular system
  • Bleeding in the brain
  • Stroke

After Procedure

  • In the case of a person with no underlying medical condition, the patient can go home on the same day of intravenous thrombolytic treatment.
  • In the case of a catheter-based thrombolytic treatment, you are likely to stay in the hospital for some days.
  • Some imaging tests may be performed for confirming the dissolution of the blood clot.
  • It is normal to have some pain and discomfort at the groin or elbow region after catheter-based thrombolysis.
  • It is normal to have some bleeding after the procedure, which may include bleeding from the nose and gums.
  • Some painkillers may be recommended 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
  • Color changes in the extremities
  • Changes in sensations or temperature in the extremities
  • Blood in urine 
  • Blood in stools
  • Fever
  • Nausea
  • Dizziness
  • Shortness of breath
  • Pain, swelling, or redness around the incision area
  • Worsening of pain in the extremities

You may be asked to take blood-thinning medications after the procedure.
In case of a blood clot that recurs, or has not dissolved completely, other treatment procedures may be required.

 

FAQ Section

1) What is Thrombolysis?

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.

 

2) What are the different types of Thrombolysis?

The different types of thrombolysis include:

  1. 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.
  2. 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.

 

3) What are the commonly used Thrombolytic agents?

The most commonly used thrombolytic agents include:

  • Retavase
  • Eminase
  • TNKase
  • Streptase
  • t-PA
  • Abbokinase
  • Kinlytic

 

4) What is Thrombolysis performed?

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

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

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

6) When should Thrombolysis be avoided?

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

 

7) What is the diagnostic procedure before Thrombolysis?

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

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

 

8) How to prepare for Thrombolysis?

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.

 

9) What is the procedure for Thrombolysis?

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.

 

10) How to care after Thrombolysis?

  • 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.

 

11) Who can do a Thrombolysis procedure?

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

 

12) What are the risks of Thrombolysis?

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)