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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.

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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 from one of the best multi-speciality hospital: S L Raheja Hospital Mahim, Mahim West, Mumbai

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