Thrombolysis

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Thrombolysis
Intervention

Thrombolysis is the breakdown (lysis) of blood clots formed in blood vessels, using medication. It is used in ST elevation myocardial infarction, stroke, and very large pulmonary embolisms.

The main complication is bleeding (which can be dangerous), and in some situations thrombolysis may therefore be unsuitable. Thrombolysis can also play an important part in reperfusion therapy that deals specifically with blocked arteries.

Medical uses[edit]

Diseases where thrombolysis is used:

Apart from streptokinase, all thrombolytic drugs are administered together with heparin (unfractionated or low molecular weight heparin), usually for 24 to 48 hours.[citation needed]

Thrombolysis is usually intravenous. It may also be used directly into the affected blood vessel during an angiogram (intra-arterial thrombolysis), e.g. when patients present with stroke beyond three hours or in severe deep vein thrombosis (catheter-directed thrombolysis).[citation needed]

Thrombolysis is performed by many types of medical specialists, including interventional radiologists, vascular surgeons, cardiologists, interventional neuroradiologists, and neurosurgeons. In some countries such as the United States of America, emergency medical technicians may administer thrombolytics for heart attacks in prehospital settings, by on-line medical direction. In countries with more extensive and independent qualifications, prehospital thrombolysis (fibrinolysis) may be initiated by the emergency care practitioner (ECP). Other countries which employ ECP's include, South Africa, the United Kingdom, and New Zealand. Prehospital thrombolysis is always the result of a risk benefit calculation of the heart attack, thrombolysis risks, and primary percutaneous coronary intervention (pPCI) availability. As such, the prehospital practitioner will often consult with the receiving cardiologist as to treatment decisions—many cardiologists have personal preferences to available treatment options.[citation needed]

Contraindications[edit]

There are absolute and relative contraindications to thrombolysis.

Absolute[edit]

Previous intracranial bleeding at any time, stroke in less than 6 months, closed head or facial trauma within 3 months, suspected aortic dissection, ischemic stroke within 3 months (except in ischemic stroke within 3 hours time), active bleeding diathesis, uncontrolled high blood pressure (>180 systolic or >100 diastolic), known structural cerebral vascular lesion, arterio-venous malformations, thrombocytopenia, known coagulation disorders, aneurysm, brain tumors, pericardial effusion, septic embolus.[citation needed]

Relative[edit]

Current anticoagulant use, invasive or surgical procedure in the last 2 weeks, prolonged cardiopulmonary resuscitation (CPR) defined as more than 10 minutes, known bleeding diathesis, pregnancy, hemorrhagic or diabetic retinopathies, active peptic ulcer, controlled severe hypertension.[citation needed]

Side-effects[edit]

Hemorrhagic stroke is a rare but serious complication of thrombolytic therapy. If a patient has had thrombolysis before, an allergy against the thrombolytic drug may have developed (especially after streptokinase). If the symptoms are mild, the infusion is stopped and the patient is commenced on an antihistamine before infusion is recommenced. Anaphylaxis generally requires immediate cessation of thrombolysis.

Agents[edit]

Thrombolysis therapy uses thrombolytic drugs that dissolve blood clots. These drugs are either derived from Streptococcus species, or, more recently, using recombinant biotechnology whereby tPA is manufactured by bacteria, resulting in a recombinant tissue plasminogen activator or rtPA.

Some thrombolytics are:

See also[edit]

  • TIMI – thrombolysis in myocardial infarction

References[edit]

  1. ^ "Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group.". Lancet (London, England). 343 (8893): 311–22. 5 February 1994. PMID 7905143. 
  2. ^ Wardlaw JM, Zoppo G, Yamaguchi T, Berge E (2003). Wardlaw, Joanna M, ed. "Thrombolysis for acute ischaemic stroke". Cochrane database of systematic reviews (Online) (3): CD000213. doi:10.1002/14651858.CD000213. PMID 12917889. 
  3. ^ Kuo WT1, Gould MK, Louie JD, Rosenberg JK, Sze DY, Hofmann LV. Catheter-directed therapy for the treatment of massive pulmonary embolism: systematic review and meta-analysis of modern techniques. J Vasc Interv Radiol. 2009 Nov;20(11):1431-40. doi: 10.1016/j.jvir.2009.08.002.PMID:19875060
  4. ^ a b c d "Therapeutic Biologic Applications (BLA) > Difficulties in Obtaining Sufficient Amounts of Urokinase (Abbokinase)". US Food and Drug Administration. 10/07/2016. Retrieved 2016-12-28.  Check date values in: |date= (help)
  5. ^ a b "Therapeutic Biologics Applications (BLA)". US Food and Drug Administration. 07-10- 2016. Retrieved 2016-12-28.  Check date values in: |date= (help)