Thrombolysis
Thrombolysis: Definition, Mechanism, Indications, and Risks
Definition
Thrombolysis, also known as fibrinolytic therapy, is a medical treatment used to dissolve dangerous blood clots (thrombi) that have formed in blood vessels. This therapy aims to restore blood flow, prevent tissue and organ damage, and is often used as an emergency intervention in conditions like heart attack (ST-elevation myocardial infarction), acute ischemic stroke, and severe pulmonary embolism1467.
Mechanism of Action
Thrombolytic drugs work by activating plasminogen, a precursor protein, and converting it into plasmin, an enzyme that digests fibrin-the main structural component of blood clots. This process breaks down the clot and helps restore normal blood flow125. The most commonly used drugs include:
- Fibrin-specific agents: Require the presence of fibrin for activation (e.g., alteplase/tPA, reteplase, tenecteplase).
- Non-fibrin-specific agents: Can activate plasminogen systemically (e.g., streptokinase, urokinase)15.
Indications
Thrombolysis is indicated for several acute, life-threatening conditions caused by blood clots, including146:
- Acute myocardial infarction (heart attack)
- Acute ischemic stroke (within 4.5 hours of symptom onset)
- Pulmonary embolism (PE)
- Deep vein thrombosis (DVT)
- Acute peripheral arterial occlusion
- Occlusion of indwelling catheters
- Intracardiac thrombus formation
Administration
Thrombolytic agents can be delivered systemically (intravenous infusion) or locally (catheter-directed to the clot site). In acute ischemic stroke, intravenous alteplase (tPA) is the mainstay and should be administered as soon as possible within the 4.5-hour window from symptom onset for best outcomes137.
Adverse Effects and Risks
- Bleeding: The most significant risk, including minor bleeding at puncture sites or severe events like intracranial hemorrhage167.
- Allergic reactions: More common with streptokinase.
- Other: Hypotension, angioedema, reperfusion arrhythmias (in heart attack), and rarely cholesterol embolism1.
Contraindications include recent intracranial hemorrhage, active bleeding, recent major surgery, severe uncontrolled hypertension, and certain other conditions that increase bleeding risk1.
Summary Table
| Aspect | Details |
|---|---|
| Purpose | Dissolve blood clots, restore blood flow, prevent tissue/organ damage |
| Main Uses | Heart attack, ischemic stroke, pulmonary embolism, DVT, arterial occlusion |
| Main Drugs | Alteplase (tPA), reteplase, tenecteplase, streptokinase, urokinase |
| Administration | IV infusion or catheter-directed |
| Main Risks | Bleeding (especially intracranial), allergic reactions, hypotension |
| Contraindications | Recent bleeding, major surgery, uncontrolled hypertension, certain brain conditions |
Thrombolysis is a powerful, life-saving therapy in selected acute vascular emergencies, but must be used with careful consideration of risks and contraindications1467.
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References:
- Miller TD, et al. “Thrombolytic Therapy: Mechanisms, Indications, and Complications.” Journal of Thrombosis and Thrombolysis. 2023;56(1):1-15.
DOI: 10.1007/s11239-022-02725-3
