Thrombolytic Treatment

Why is the doctor performing this procedure?

To directly inject medicines capable of breaking apart harmful, rigid blood clots. This therapy can be life-saving during or shortly after a heart attack.

What is the procedure?

"Thrombus" is blood clot; "lytic" or "lysis" means to break apart. So, thrombolytic therapy is used to break up a blood clot that is causing partial or full obstruction of blood flow in an artery. A blood clot in a brain artery can lead to stroke; a blood clot in a heart artery can lead to a heart attack.

There are two methods of thrombolytic therapy: Intravenous (IV) and catheter-based.

IV therapy involves placement of an IV line in a vein to disperse medication throughout the body. This technique is used to destroy blood clots in non-specific areas (often in patients having a heart attack). Following slow perfusion of the medication, the IV lines are removed. Removal can only occur once fibrinogen levels (blood clotting levels) return to normal (usually the next day).

For precise delivery of medicine directly to a blood clot, a catheter-based approach is used. During this procedure, a perfusion catheter is inserted into an artery, usually in the groin (the femoral artery). It is then advanced to the blood clot. Once properly positioned, the medicine is injected thru the catheter and into the clot, where it begins to destroy the clot immediately. As the clot disappears, blood flow resumes. One may still see a plaque or a hard clot. If a plaque is present, this may indicate the need for further treatment (See angioplasty ). In some cases, thrombolytic therapy is used to soften, hard (difficult to break) blood clots. Once the clot is softened, your doctor may crush the clot using an angioplasty or atherectomy technique.

Once the blood levels are normalized, the catheter is removed, and pressure is applied to the catheter site to stop bleeding. Some examples of thrombolytic medicines used for this procedure include:

• Alteplase
• Retenplase
• Streptokinase
• Urokinase
• Eminase
• TPA (Tissue Plasminogen Activator)

Where is the procedure performed?

In the Cardiac Catheterization Lab or Interventional Radiology Suite.

How long does this procedure take?

Thrombolytic therapy takes about an hour.