Thrombolytic Therapy

What 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:

• If a blood clot suddenly blocks a major vein or artery.
• If blood-thinning medications (anticoagulants) haven’t reduced blood clots related to DVT, pulmonary embolism (PE) or PAD.

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:

• Active bleeding.
• Recent brain bleed/hemorrhage (intracranial hemorrhage).
• Recent brain surgery or spine surgery.
• Severe high blood pressure (hypertension).
• Severe kidney disease.
• Recent traumatic brain injury.

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:

• Blockages in coronary arteries (heart attacks) if stents or surgery are not an option.
• Clots inside your blood vessels (thrombosis).
• DVT that is complicated by venous blood flow obstruction characterized by pain and cyanosis (blue skin coloring) or people who fail blood thinners.
• Heart attack (myocardial infarction).
• Ischemic stroke.
• PAD.
• Blood clots in the lung (pulmonary embolism).
• Problems due to long-term catheter use (catheter occlusion).
• Sudden decrease in blood flow to your limbs (acute peripheral arterial occlusion).

What are the types of thrombolytic therapy?

Providers use three types of thrombolysis:

• Systemic thrombolysis: An IV line that delivers medication into your bloodstream. Often used as an emergency procedure for conditions such as heart attack, PE and stroke.
• Catheter-directed thrombolysis: A long catheter that brings medication directly to the blood clot. Often used as a scheduled procedure to treat DVT and PAD.
• Mechanical thrombectomy: A long catheter with a rotating or ultrasound device, suction cup or fluid jet at the end that breaks up or suctions the clot. Sometimes used along with catheter-directed thrombolysis.

What 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:

• Two hours of when your symptoms began.
• Thirty minutes of your arrival at the hospital.

What happens during thrombolytic therapy?

What happens during thrombolytic therapy depends on whether it’s systemic thrombolysis or catheter-directed thrombolysis.

Systemic thrombolysis

Your provider will usually deliver systemic thrombolytic therapy through an IV line in an intensive care unit (ICU). Your surgical team:

1. Gives you a sedative to relax you.
2. Uses a local anesthetic to numb the area for the IV.
3. Inserts the IV line into a vein in your arm. The thrombolytic medication travels through your bloodstream until it reaches the blood clot.
4. Removes the IV after the procedure and the incision is closed with a sterile plug.

The procedure usually takes about one hour.

Catheter-directed thrombolysis

For a scheduled procedure, your provider usually uses catheter-directed thrombolysis. The team:

1. Gives you a sedative to relax you.
2. Uses a local anesthetic to numb the area where they’ll insert a long, thin tube (catheter).
3. Makes a small incision in your neck, groin, arm or behind your knee. Then place the catheter through a vein.
4. Puts the medication into the catheter that travels to the blood clot. They may also use a device on the end of the catheter to break up or suction the clot (mechanical thrombectomy). The medication may take up to two days to work. You stay in the hospital so your team can watch the blood clot.
5. Looks for any narrowed areas of your vein that may have caused a blood clot. Your team can open these areas with an angioplasty or stent.
6. Removes the catheter after the procedure. They close the incision with a sterile plug.

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:

• Angiogram.
• CT scan.
• Echocardiogram.
• X-ray to see how blood moves through your veins (venogram).

What are the advantages of thrombolytic therapy?

Thrombolytic therapy can dissolve blood clots that, if untreated, may cause:

• Disability.
• Loss of limbs.
• Death.

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:

• Allergic reactions.
• Bleeding in the nose, stool or urine.
• Bleeding or bruising at the site of IV or catheter insertion.
• Blood vessel
• Kidney damage, especially if you have diabetes.
• Low blood pressure (hypotension).
• Movement of the blood clot to another part of your body.
• Swollen tissue (angioedema).
• Ventricular arrhythmia.

What is the recovery time after thrombolytic therapy?

After receiving thrombolytics, you may need to spend:

• At least one day in the ICU.
• One to three days in the hospital for observation. Your medical team will make sure your clots have dissolved.

Systemic thrombolysis

After you go home, you’ll likely need to take blood-thinning medication to prevent future blood clots from forming.

Catheter-directed thrombolysis

Your 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 should I see my healthcare provider?

Talk to your healthcare provider if you have any of these symptoms after thrombolytic therapy:

• Chest pain.
• Continued bleeding or leaking fluid at the IV or catheter insertion site.
• Fever.
• Nausea or headache that continues to get worse.
• Tingling or numbness in your arms or legs.
• Warmth or redness at the IV or catheter insertion site.
• Worsening pain or swelling (edema) at the IV or catheter insertion site.

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.