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    Thrombolytic therapy

    Tissue plasminogen activator; TPA; Alteplase; Reteplase; Tenecteplase; Activase thrombolytic agent; Clot-dissolving agents; Reperfusion therapy

    Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.

    Information

    Thrombolytic medications are approved for the immediate treatment of stroke and heart attack. The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA), but other drugs can do the same thing.

    According to the American Heart Association, you have a better chance of surviving and recovering from certain types of heart attacks if you receive a thrombolytic drug within 12 hours after the heart attack starts.

    Ideally, you should receive thrombolytic medications within the first 90 minutes after arriving at the hospital for treatment.

    HEART ATTACKS

    A blood clot can block the arteries to the heart. This can cause a heart attack, when part of the muscle dies due to a lack of oxygen being delivered by the blood.

    Thrombolytics work by dissolving a major clot quickly. This helps restart blood flow to the heart and helps prevent damage to the heart muscle. Thrombolytics can stop a heart attack that would otherwise be deadly.

    The drug restores some blood flow to the heart in most patients. However, the blood flow may not be completely normal and there may still be a small amount of muscle damaged. Additional therapy, such as cardiac catheterization or angioplasty, may be needed.

    Your health care provider will base the decisions about whether to give you a thrombolytic medication for a heart attack on many factors. These factors include your history of chest pain and the results of an ECG test.

    Other factors used to determine if you are a good candidate for thrombolytics include:

    • Age (older patients are at increased risks of complications)
    • Gender
    • Medical history (including your history of a previous heart attack, diabetes, low blood pressure, or increased heart rate)

    Generally, thrombolytics will not be given if you have:

    • A recent head injury
    • Bleeding problems
    • Bleeding ulcers
    • Pregnancy
    • Recent surgery
    • Taken blood thinning medications such as Coumadin
    • Trauma
    • Uncontrolled (severe) high blood pressure

    STROKES

    Most strokes are caused when blood clots move to a blood vessel in the brain and block blood flow to that area. For such strokes (ischemic strokes), thrombolytics can be used to help dissolve the clot quickly. Giving thrombolytics within 3 hours of the first stroke symptoms can help limit stroke damage and disability.

    The decision to give the drug is based upon:

    • A brain CT scan to make sure there has not been any bleeding
    • A physical exam that shows a significant stroke
    • Your medical history

    As in heart attacks, a clot-dissolving drug isn't usually given if you have one of the other medical problems listed above.

    Thrombolytics are not given to someone who is having a hemorrhagic stroke (a hemorrhagic stroke means there has been bleeding in the brain). They could worsen the stroke by causing increased bleeding.

    There are various drugs used for thrombolytic therapy, but t-PA are used most often. Others drugs include:

    • Lanoteplase
    • Reteplase
    • Staphylokinase
    • Streptokinase (SK)
    • Tenecteplase
    • Urokinase

    ALTERNATIVES

    Alternatives to thrombolytic therapy include interventional therapies done via catheters such as balloon angioplasty (PTCA), with or without stenting, thrombectomy (removing the clot).

    Hemorrhage or bleeding is the most common risk. It can be life-threatening.

    Minor bleeding from the gums or nose can occur in approximately 25% of people who receive the drug. Bleeding into the brain occurs approximately 1% of the time. This risk is the same for both stroke and heart attack patients.

    CONTACT A HEALTH CARE PROVIDER OR CALL 911

    Heart attacks and strokes are medical emergencies. The sooner treatment with thrombolytics begins, the better the chance for a good outcome.

    References

    Anderson JL. ST segment elevation acute myocardial infarction and complications of myocardial infarction. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 73.

    Antman EM, Morrow DA. ST-segment elevation myocardial infarction: management. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 55.

    Kushner FG, Hand M, Smith SC Jr, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009 Dec 1;120(22):2271-306. Epub 2009 Nov 18.

    Zivin JA. Ischemic cerebrovascular disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 414.

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            Review Date: 6/18/2012

            Reviewed By: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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