Sarah Lewis, PharmD
What is thrombolysis?
Thrombolysis treats blood clots and prevents serious and life-threatening complications. It involves using medication to break up or dissolve a blood clot that has formed inside a blood vessel. Blood clots can grow, break loose, and cut off blood supply to organs and tissues. This can cause a stroke, heart attack, and other serious problems. Your doctor may use thrombolysis as an emergency or scheduled treatment, depending on your condition.
Thrombolysis is a minor procedure, but it still involves some risk. It is only one method used to treat blood clots. Discuss all of your options with your doctor to understand which options are right for you.
Types of thrombolysis
The types of thrombolysis include:
Catheter-based thrombolysis involves an incision in your groin through which your doctor inserts a catheter. Your doctor guides the catheter to the clot site and injects medication or uses special instruments to break up the clot.
Intravenous (IV) thrombolysis involves injecting medication through an IV. The medication travels to the site of the clot to dissolve it or break it up.
Other procedures that may be performed
Your doctor may also perform an angiography along with your thrombolysis. An angiography is an imaging procedure that allows your doctor to take a picture (an angiogram) of your blood vessels.
Why is thrombolysis performed?
Your doctor may recommend thrombolysis to treat:
Blood clots in catheters or grafts, including dialysis catheters, central venous catheters, and bypass grafts
Blood clots in peripheral arteries, arteries that supply the arms and legs with blood
Deep vein thrombosis (DVT), which is a clot that develops in a vein in the legs or pelvis. A DVT can break off and travel through the body and cause blockage of a lung artery (pulmonary embolism)
Heart attack, which occurs when a clot develops or lodges in an artery that supplies the heart muscle. It causes heart muscle to die from lack of oxygen
Pulmonary embolism (PE), which is a clot that lodges in an artery in the lung
Stroke, which occurs when a clot develops or lodges in an artery in the brain (ischemic stroke)
Who performs thrombolysis?
The following specialists commonly perform thrombolysis:
Interventional cardiologists specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging.
Neuroradiologists specialize in diagnosing and treating diseases and conditions of the brain, spine, head, neck and nerves using radiation and other imaging technologies.
Neurosurgeons specialize in the medical and surgical care of people with diseases and conditions of the brain and nervous system.
Vascular and interventional radiologists specialize in the treatment of blood vessel conditions and other diseases using catheter-based procedures and imaging techniques.
Vascular surgeons specialize in the surgical treatment of blood vessel diseases.
Other specialists who perform thrombolysis include:
Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.
Cardiologists specialize in diagnosing and treating conditions of the heart and its blood vessels.
Critical care medicine doctors care for patients with acute, life-threatening illnesses or injuries.
Pulmonologists specialize in the medical care of people with breathing problems and diseases and conditions of the lungs.
Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.
How is thrombolysis performed?
Your thrombolysis will be performed in a hospital. Where and how your doctor performs your thrombolysis will depend on the type of clot you have and whether or not you are in an emergency situation. If you are not having an emergency, your doctor may schedule your thrombolysis.
Thrombolysis is a minor procedure that involves the following steps:
You will dress in a patient gown and lie on a procedure table.
Your nurse or technician will insert an IV.
A nurse will generally inject the clot-busting medication through your IV for IV thrombolysis. The medication will travel to the site of the clot to dissolve it.
If you are having a catheter-based thrombolysis, your team will clean and shave an area on your groin. They will cover the area with sterile drapes. In some cases, your elbow will be the site for your procedure.
Your team will place painless electrodes on your chest and attach them to an EKG (electrocardiogram) machine.
Your doctor will use a local anesthetic to numb your groin. You may have sedative medication to help you relax.
Your doctor will make an incision in your groin and insert and guide the catheter to the clot site.
Your doctor will inject the clot-busting medication or use special instruments to break up the clot once the catheter is in place.
Your doctor will remove the catheter and your team will remove the electrodes and your IV line.
You will need to lie flat for up to six hours after the procedure.
Will I feel pain with thrombolysis?
Your comfort and relaxation is important to both you and your care team. You may feel a pinch and brief stinging during the IV insertion and local anesthetic injection. You may also feel pressure during the incision, but you should not feel pain during the procedure. You will have enough pain and sedative medications so you stay comfortable. Tell your doctor or a member of your healthcare team if you feel chest discomfort or other symptoms during the procedure.
What are the risks and potential complications of thrombolysis?
Complications of thrombolysis can occur and become serious in some cases. Complications can develop during the procedure or recovery. Risks and potential complications of thrombolysis include:
Bleeding or hemorrhage, which can be life-threatening
Damage to blood vessels
Low blood pressure
Reducing your risk of complications
You can reduce the risk of certain complications by:
Following activity, exercise and lifestyle restrictions and recommendations
Following instructions after the procedure exactly
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Keeping all scheduled appointments
Notifying your doctor immediately of any concerns, such as dizziness, fainting, or new symptoms
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my thrombolysis?
You are an important member of your own healthcare team. The steps you take before your thrombolysis can improve your comfort and outcome. In an emergency thrombolysis, you will not have time to prepare. However, you can prepare for a scheduled thrombolysis by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Not eating or drinking as directed before the treatment.
Taking or stopping medications exactly as directed. Ask your doctor for specific instructions about taking your medications before thrombolysis.
Questions to ask your doctor
Having a scheduled thrombolysis can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need thrombolysis? Are there any other options for treating my condition?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my regular medications?
How will you treat my pain, if any?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my thrombolysis?
Knowing what to expect after thrombolysis can help you get back to your everyday life as soon as possible.
What can I expect after the thrombolysis?
You may have discomfort at your groin or elbow site after a catheter-based thrombolysis. To reduce discomfort, take slow deep breaths. You may receive medication to control your pain. Tell a member of your care team if your pain is not well controlled by your medication because it can be a sign of a complication.
Minor bleeding can occur in up to 25% of people who have thrombolysis. This includes bleeding gums or nosebleeds. Tell your doctor about any bleeding.
When can I go home?
You may go home the same day or stay in the hospital for treatment of the underlying condition that caused the blood clot. You will likely stay in the hospital for several days or more if your thrombolysis was part of an emergency treatment for a heart attack or stroke.
When should I call my doctor?
It is important to keep your follow-up appointments after thrombolysis. Contact your doctor if you have concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bloody urine or stools
Changes in color, temperature or feeling in the extremities
Chest pain or pressure
New or unusual symptoms
Pain, swelling or redness around the incision
Persistent or worsening pain in the extremities
Shortness of breath
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- Catheter-directed Thrombolysis. American College of Radiology. http://www.radiologyinfo.org/en/info.cfm?pg=thrombo
- Thrombolytic Therapy. Society for Vascular Surgery. http://www.vascularweb.org/vascularhealth/Pages/thrombolytic-therapy.aspx
- Thrombolytic Therapy. The Ohio State University. http://medicalcenter.osu.edu/heart/conditions/Pages/Treatments/ThrombolyticTherapy.aspx
- Roberts JR, Hedges JR (eds.) Clinical Procedures in Emergency Medicine (5th Ed.) Philadelphia: Saunders, 2010.