Journal of Vascular and Endovascular Therapy

Editorial

Thrombolysis, is also called thrombolytic therapy, is a treatment to break up risky clusters in veins, further develop blood stream, and forestall harm to tissues and organs. Thrombolytic therapy is the administration of drugs called lytics or “clot busters” to dissolve blood clots that have acutely (suddenly) blocked your major arteries or veins and pose potentially serious or lifethreatening implications. To be effective, the therapy needs to be initiated as soon as possible, before permanent damage has occurred. Thrombolysis might include the infusion of cluster busting drugs through an intravenous (IV) line or through a long catheter that conveys sedates straightforwardly to the site of the blockage. It additionally may include the utilization of a long catheter with a mechanical gadget appended to the tip that either eliminates the coagulation or actually splits it up. The length of a treatment session varies depending on the underlying cause. A session can take from 60 minutes (typical for a heart attack) to 48 hours (often the case for deep vein thrombosis, or DVT).

Thrombolysis is used as an emergency treatment to dissolve blood clots that form in arteries feeding the heart and brain -- the main cause of heart attacks and ischemic strokes and in the arteries of the lungs (acute pulmonary embolism).

Thrombolysis is also used to treat blood clots in:

• Bypass grafts

• Dialysis catheters

Types of Thrombolytic Therapy

The most regularly utilized clump busting drugs called thrombolytic specialists - include:

• Eminase (anistreplase)

• Retavase (reteplase)

• Streptase (streptokinase, kabikinase)

• t-PA (class of drugs that includes Activase)

• TNKase (tenecteplase)

• Abbokinase, Kinlytic (rokinase)

Risks of Thrombolytic Therapy

Bleeding is the most common risk. It can be life threatening. Minor bleeding from the gums or nose can occur in approximately 25% of people who receive the drug. Bleeding into the brain occurs approximately 1% of the time. This risk is the same for both stroke and heart attack patients. If thrombolytics are felt to be too dangerous, other possible treatments for clots causing a stroke or heart attack include:

• Removal of the clot (thrombectomy)

• A procedure to open narrowed or blocked blood vessels that supply blood to the heart or the brain

• Severe high blood pressure

• Active bleeding or severe blood loss

• Hemorrhagic stroke from bleeding in the brain

• Severe kidney disease

• Recent surgery

Thrombolysis also may be associated with an increased risk of complications in patients who are pregnant or at an advanced age, and in people with other conditions.

Patients who undergo thrombolysis have a small risk of infection (less than one in 1,000) as well as a slight risk of an allergic reaction to the contrast dye that may be needed for imaging. Besides risk of serious internal bleeding, other possible risks include:

• Bruising or bleeding at the access site

• Damage to the blood vessel

• Migration of the blood clot to another part of vascular system

• Kidney damage in patients with diabetes or other pre-existing kidney disease

The most serious possible complication is intracranial bleeding, which is potentially fatal. But this complication is rare. Bleeding in the brain that causes stroke occurs in less than 1% of patients.