Definition
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. The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA).
Alternative Names
Tissue plasminogen activator; TPA; Alteplase; Reteplase; Tenecteplase; Activase thrombolytic agent; Clot-dissolving agents; Reperfusion therapy
Information
tPA is approved for the immediate treatment of stroke and heart attack . According to the American Heart Association, giving tPA within the first 3 hours of a stroke can help reduce the person’s chances for disability. If you get the drug within 12 hours after a heart attack started, you have a better chance for survival and recovery.
The sooner thrombolytic therapy is given, the better your outcome.
FOR HEART ATTACKS
A blood clot can block the arteries to the heart. This can cause a heart attack. tPA works by dissolving a major clot quickly. This helps re-start blood flow to the heart and help prevent damage to the heart muscle. tPA can stop a heart attack that would otherwise be deadly.
The drug restores some blood flow to the heart in about 75% of patients. However, the blood flow may not be completely normal. Additional therapy, such as cardiac catheterization, may be needed.
Your health care provider will base the decisions about whether to give you tPA for a heart attack on many factors, including your history of chest pain and the results of an ECG test .
Other factors used to determine if you are a good candidate for tPA include age, gender, and medical history, including your history of a previous heart attack, diabetes, low blood pressure, or increased heart rate.
Generally, tPA will not be given if you have had a recent head injury, trauma, surgery, bleeding problems, uncontrolled high blood pressure, bleeding ulcers, or if you are pregnant.
FOR STROKES
The majority of strokes are caused when blood clots moved to a blood vessel in the brain and block blood flow to that area. For such strokes (ischemic strokes), tPA can be used to help dissolve the clot quickly. Giving tPA quickly, especially within 3 hours of the first stroke symptoms, can help limit stroke damage and disability.
The decision to give the drug is based upon your medical history, a physical exam that shows a significant stroke, and a brain CT scan to make sure there is no bleeding.
tPA is not given if someone is having a hemorrhagic stroke because this could worsen the stroke by causing increased bleeding.
RISKS
There are various drugs used for thrombolytic therapy, but tPA is used most often. Others drugs include Streptokinase (SK), Reteplase, Tenecteplase, Urokinase, Lanoteplase, and Staphylokinase.
Hemorrhage or bleeding is the most common risk. 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 tPA takes place, the better the chance for a good outcome.
See also:
- Stroke
- Heart attack
References
Ocava LC. Antithrombotic and thrombolytic therapy for ischemic stroke. Clin Geriatr Med . 2006; 22(1): 135-54.
Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine , 7th ed. St. Louis, Mo; WB Saunders; 2005:22.