OverviewWhat is thrombolytic therapy?Thrombolytic therapy (also called thrombolysis) is the use of medications to dissolve blood clots. Thrombolysis reduces damage to your body’s organs and tissues when there are clots by improving blood flow. Healthcare providers may use thrombolytic therapy as an emergency treatment if you have acute obstructions to normal blood flow, such as a heart attack, stroke or blood clots in the lungs (pulmonary embolism). Your provider must start these medications as soon as possible to increase the chance of success. Thrombolytic therapy can also help dissolve blood clots related to deep vein thrombosis (DVT), peripheral arterial disease (PAD) and other conditions. Healthcare providers give thrombolytic therapy either through an IV or through a long, thin tube (catheter). Who needs to have thrombolytic therapy?You may need thrombolytic therapy:
Who shouldn’t have thrombolytic therapy?Healthcare providers don’t recommend thrombolytic therapy if you have conditions related to an increased risk of bleeding, such as:
People who are pregnant or elderly also have an increased risk of complications. What conditions are treated with thrombolytic therapy?Providers may use thrombolytic therapy to treat:
What are the types of thrombolytic therapy?Providers use three types of thrombolysis:
Procedure DetailsWhat happens before thrombolytic therapy?If you have an emergency, such as a heart attack, stroke or PE, your provider will start thrombolytic therapy as soon as possible. For the best outcomes, they aim to start it within:
What happens during thrombolytic therapy?What happens during thrombolytic therapy depends on whether it’s systemic thrombolysis or catheter-directed thrombolysis. Systemic thrombolysisYour provider will usually deliver systemic thrombolytic therapy through an IV line in an intensive care unit (ICU). Your surgical team:
The procedure usually takes about one hour. Catheter-directed thrombolysisFor a scheduled procedure, your provider usually uses catheter-directed thrombolysis. The team:
While the medication is working to break up the blood clot, your team uses X-rays to monitor its progress. They will also check your heart and lungs and watch your blood pressure. It can take up to 48 hours for the clot to dissolve. What happens after thrombolytic therapy?After thrombolytic therapy, your healthcare provider will use imaging tests to see if they’ve completely removed the blood clot. They may use the following tests:
Risks / BenefitsWhat are the advantages of thrombolytic therapy?Thrombolytic therapy can dissolve blood clots that, if untreated, may cause:
What are the risks or complications of thrombolytic therapy?The main risk of thrombolytic therapy is internal bleeding. About 5% of people who have thrombolytic therapy have major bleeds and about 1% have brain bleeds that cause a stroke. Other risks include:
Recovery and OutlookWhat is the recovery time after thrombolytic therapy?After receiving thrombolytics, you may need to spend:
Systemic thrombolysisAfter you go home, you’ll likely need to take blood-thinning medication to prevent future blood clots from forming. Catheter-directed thrombolysisYour provider may give you medication after the procedure to make sure the clot dissolves. This can take from 12 to 14 hours. They will also put a compression stocking on your arm or leg if the procedure was performed for peripheral occlusion. In cases of pulmonary embolism or heart attacks, stockings are not needed. You’ll probably need to take a blood-thinning medication for three to six months after the procedure. What is the outlook after thrombolytic therapy?Thrombolytic therapy usually successfully dissolves blood clots. But up to 25% of people still have a blood clot after thrombolytic therapy. About 12% of people develop a blood clot or blood vessel blockage again. Your provider may also suggest another type of minimally invasive surgery to treat the underlying cause of the blood clot. When to Call the DoctorWhen should I see my healthcare provider?Talk to your healthcare provider if you have any of these symptoms after thrombolytic therapy:
A note from Cleveland Clinic Thrombolytic therapy (thrombolysis) uses drugs (thrombolytics) to get rid of blood clots. Healthcare providers use this treatment for health emergencies such as heart attack, pulmonary embolism and stroke. Thrombolysis also treats blood clots due to deep vein thrombosis or peripheral artery disease. Providers insert an IV line or catheter for thrombolytic therapy. This procedure can take from one hour to 48 hours. Risks of thrombolytic therapy include internal bleeding and low blood pressure. While this treatment most often dissolves blood clots, you may need another surgery to treat the underlying cause. Which conditions are contraindicated for thrombolytic therapy?Contraindications. Recent intracranial hemorrhage (ICH). Structural cerebral vascular lesion.. Intracranial neoplasm.. Ischemic stroke within three months.. Possible aortic dissection.. Active bleeding or bleeding diathesis (excluding menses). Significant head injury or facial trauma within three months.. In what situation would you not use a thrombolytic therapy treatment?Healthcare providers don't recommend thrombolytic therapy if you have conditions related to an increased risk of bleeding, such as: Active bleeding. Recent brain bleed/hemorrhage (intracranial hemorrhage). Recent brain surgery or spine surgery.
Which of the following is an absolute contraindication for thrombolytic therapy?Absolute contraindications for fibrinolytic use in STEMI include the following: Prior intracranial hemorrhage (ICH) Known structural cerebral vascular lesion. Known malignant intracranial neoplasm.
Which condition is a contraindication for thrombolytic therapy in the treatment of an acute MI?Factors That Should Not Be Considered Contraindications
Active bleeding at the time of presentation with acute myocardial infarction is usually considered a contraindication against the use of thrombolytic therapy.
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