What you need to know about Thrombolytic Therapy!

Imagine that our body's blood vessel system is like a network of roads in a busy city. Blood travels along these roads continuously to nourish all our organs, such as our heart, brain, and lungs. So, what happens if this main road, that is, a blood vessel, suddenly gets blocked by a large blood clot? Just like a major accident on the road and traffic jams, the blood supply to our organs can stop, leading to a very dangerous situation like a heart attack or stroke. Today, we are talking about a very important treatment that doctors use to dissolve such a life-threatening blood clot and restore blood flow.

Simply put, what is Thrombolytic Therapy?

This means 'blood clot dissolving treatment' in Sinhala. Simply put, this involves administering very powerful drugs (thrombolytics) to the body to dissolve dangerous blood clots that are stuck inside the blood vessels. Once the clot dissolves, the blocked blood vessel reopens and blood flow to the affected organ is restored. This is a life-saving treatment used in very emergency situations . The sooner this treatment is started, the more likely it is to be successful.

Who needs this treatment and in what cases?

Doctors usually consider this treatment in serious, emergency situations such as the following.

• Myocardial Infarction: When a blood clot blocks a coronary artery that supplies blood to the heart, especially when there is no immediate stent placement or surgery available.
• Ischemic Stroke: A stroke caused by a blood clot blocking an artery that supplies blood to the brain.
• Pulmonary Embolism: When a blood clot that forms elsewhere in the body (usually in the legs) breaks loose and becomes lodged in a vein in the lungs.
• Deep Vein Thrombosis (DVT): Large blood clots, especially in the deep veins of the legs, cause complications such as blueness of the legs, severe pain, and do not respond to common blood-thinning medications (anticoagulants).
• Acute Peripheral Arterial Occlusion: A blood clot blocks a major artery in an arm or leg .

Are there people who should not receive this treatment?

Yes, absolutely. Since the main risk of this treatment is bleeding, it is not given to some patients. Because for them, the harm from the treatment may outweigh the benefit.

Additionally, doctors think twice about this because pregnant mothers and the elderly are at higher risk of complications.

How is this treatment performed?

There are two main methods of treatment, depending on your condition and urgency.

1. Systemic Thrombolysis

This is the method most commonly used in emergencies (heart attack, stroke).

• This involves administering blood clot-dissolving medication directly into the bloodstream through an IV cannula placed in a vein in the arm.
• This medicine travels with the blood, goes to the site of the blood clot, and begins to dissolve it.
• This procedure is usually performed in an intensive care unit (ICU) . The entire procedure can take about an hour.

2. Catheter-directed Thrombolysis

This method is often used for pre-planned treatments like DVT or PAD.

• In this procedure, a small hole is made through the skin of the groin, neck, or arm, and a very thin, long tube called a catheter is inserted through it along the blood vessel.
• Using X-ray-like technology, the tip of this catheter is directed precisely to the location of the blood clot.
• Then, the medication is injected directly into the blood clot through the catheter. Sometimes, a special device at the end of the catheter can be used to break up the blood clot (mechanical thrombectomy).
• This method can take up to 48 hours (2 days) for the blood clot to completely dissolve. During this time, you will be kept in the hospital and monitored by the medical team.

What are the risks and complications of treatment?

As with any medical treatment, there are some risks.

In addition to this main risk, there is also a small chance that the following things will happen:

• Allergic reactions to the drug.
• Bleeding or bruising where the cannula or catheter was inserted.
• Low blood pressure (hypotension).
• A small piece of the dissolving blood clot breaks off and gets stuck in another blood vessel.
• Kidney damage (especially in people with diabetes).
• Small amounts of blood coming out of the nose, with stool, or with urine.

Your doctor will explain these risks to you or your caregivers before treatment.

After treatment and recovery

After treatment, the doctor will perform several tests, such as an angiogram and CT scan, to see if the blood clot has completely dissolved.

You will need to stay in the intensive care unit (ICU) for at least a day, followed by another one to three days under observation in a general ward.

After you go home, your doctor will likely prescribe blood thinners to prevent blood clots from forming again . It is very important to follow these instructions exactly.

Warning signs that you should see a doctor after going home

If you experience any of the following symptoms, inform your doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.

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