Name of the Procedure:

Thrombolysis, Coronary; by Intravenous Infusion
Common name: Clot-busting therapy, IV thrombolysis
Technical term: Coronary thrombolysis

Summary

Thrombolysis by intravenous infusion is a medical procedure where medication is administered through a vein to dissolve blood clots in the arteries of the heart. This helps restore proper blood flow and can prevent or minimize damage to the heart muscle during a heart attack.

Purpose

Medical Condition: Acute myocardial infarction (heart attack)
Goals: Re-establish blood flow to the heart, reduce the amount of heart muscle damage, improve overall heart function, and prevent further complications or death related to heart attacks.

Indications

• Symptoms of a heart attack, such as chest pain, shortness of breath, and sweating
• Confirmed diagnosis of a blood clot in the coronary arteries through diagnostic tests
• Patients for whom immediate mechanical intervention (like angioplasty) is not available

Preparation

• Patients may need to undergo an electrocardiogram (ECG) and blood tests to confirm a heart attack and determine health status.
• Instructions may include fasting for a few hours before the procedure if possible.
• Adjustments in ongoing medications, especially blood thinners or anticoagulant medications.

Procedure Description

1. Pre-procedure Preparation: Patient is connected to monitors to track heart rate and blood pressure.
2. IV Infusion: A catheter is inserted into a vein, usually in the arm.
3. Administration of Thrombolytic Agent: Medicine, such as tissue plasminogen activator (tPA), is infused through the IV line.
4. Observation: The patient is closely monitored for response to the medication, including changes in symptoms and vital signs.

Tools used include IV catheter, infusion pump, and medications (e.g., tPA). No sedation required, but pain-relief medications may be given if necessary.

Duration

The procedure typically takes about 30-60 minutes for the infusion, but monitoring continues for several hours to ensure patient stability.

Setting

Performed in a hospital setting, often in an emergency room or intensive care unit.

Personnel

• Emergency medicine physician or cardiologist
• Nurses specialized in cardiac care
• Pharmacist for medication preparation

Risks and Complications

• Common risks: Bleeding at the catheter insertion site, mild allergic reactions to the medication
• Rare risks: Severe bleeding (including intracranial hemorrhage), embolization, hypotension
• Management: If any severe complications arise, immediate measures, such as blood transfusion or reversal agents, may be employed.

Benefits

• Rapid dissolution of blood clots
• Improved chances of survival following a heart attack
• Decreased long-term damage to the heart muscle
• Benefits are usually realized within hours as blood flow is restored.

Recovery

• Patients are monitored in the hospital for several days.
• Follow-up care includes medications to prevent future clots, cardiac rehabilitation, dietary changes, and lifestyle modifications.
• Recovery time typically spans a few weeks with gradual resumption of normal activities.

Alternatives

• Angioplasty and stent placement: Mechanically opening the blocked artery
• Coronary artery bypass grafting (CABG): Surgical alternative to create a new path for blood flow
• Medications: Long-term anticoagulant and antiplatelet therapy
• Pros and Cons: Mechanical methods like angioplasty might be more immediate but require availability and surgical expertise; thrombolysis is less invasive but carries bleeding risks.

Patient Experience

• During the procedure: Patients may feel some discomfort during the IV insertion and infusion but are typically awake and alert.
• After the procedure: Patients may experience monitoring in the ICU, some bruising at the IV site, and will be closely observed for signs of bleeding or other complications. Pain management and comfort measures are administered as needed.