If you have had an ischaemic stroke (due to a clot) you will usually be given an antiplatelet drug, usually aspirin. Antiplatelets help to stop clots from forming in your blood. Some people with ischaemic stroke are eligible for a clot-busting drug. The drug aims to disperse the clot and return the blood supply to your brain. The medicine itself is called alteplase, or recombinant tissue plasminogen activator (rt-PA). The process of giving this medicine is known as thrombolysis. Thrombolysis can break down and disperse a clot that is preventing blood from reaching your brain. For most people, thrombolysis needs to be given within four and a half hours of your stroke symptoms starting. In some circumstances, your doctor may decide that it could still be of benefit within six hours. However, the more time that passes, the less effective thrombolysis will be. This is why it’s important to get to the hospital as quickly as possible when your symptoms start. After thrombolysis, 10% more patients survive and live independently. Despite its benefits, there is a risk that thrombolysis can cause bleeding in your brain. This happens to about one in 25 people within seven days of thrombolysis, and this can be fatal in about one in 40 cases. The sooner you are treated, the better the chances of improvement, and the lower the risk of harm. Who can have thrombolysis? Not everyone who has an ischaemic stroke is suitable for thrombolysis. At present, around 12% of people who are admitted to the hospital with a stroke are eligible to receive it. If you are not suitable, it may be because:
ThrombectomyThrombectomy is a treatment that physically removes a clot from the brain. It usually involves inserting a mesh device into an artery in your groin, moving it up to the brain, and pulling the clot out. It only works with people where the blood clot is in a large artery. Like thrombolysis, it has to be carried out within hours of a stroke starting. Only a small proportion of stroke cases are eligible for thrombectomy but it can have a big impact on those people by reducing disability. Haemorrhagic strokeIf you have a haemorrhagic stroke (due to bleeding in or around the brain) you might be given treatments for high blood pressure. If you're on anticoagulants you'll be given medication to reverse the effects and reduce bleeding. If a bleed is due to a burst aneurysm (weakened blood vessel), you might have a surgical procedure to repair the blood vessel. Surgery is also used to reduce pressure caused by a build-up of fluid. To avoid further damage to the brain due to lack of blood supply, you may be given a drug called nimodipine. You'll be given pain relief to help with the headaches that a bleed can cause. ShareJournal Article Murat Ugurlucan, Goztepe Safak Hospital Cardiovascular Surgery Clinic, Istanbul, Turkey Search for other works by this author on: Murat Basaran,Goztepe Safak Hospital Cardiovascular Surgery Clinic, Istanbul, Turkey Search for other works by this author on: Nuri Kurtoglu,Goztepe Safak Hospital Cardiovascular Surgery Clinic, Istanbul, Turkey Search for other works by this author on: Melih H. UsGoztepe Safak Hospital Cardiovascular Surgery Clinic, Istanbul, Turkey Search for other works by this author on:
Close Navbar Search Filter Microsite Search Term Search We read with great interest the article by Firstenberg et al. [1] presenting a case of post-myocardial infarction (MI) ventricular septal defect (VSD) and intracranial hemorrhage following thrombolytic therapy after acute stent occlusion. We would like to comment the authors' aritcle with our modest experience of similar complications. Myocardial or aortic rupture, aortic dissection, intracranial hemorrhage, or even splenic rupture are potential fatal complications of thrombolytic therapy following acute myocardial infarction. They usually occur in elderly (>65 years of age), moderate body weight (<70 kg) female subjects. Hypertension at presentation and usage of tissue plasminogen activator (t-PA) rather than streptokinase have shown to be additional risk factors. Of the most important, timing of the lytic therapy is accepted as the critical factor for post-MI VSD and intracranial bleeding. Initiation of the therapy beyond 12 h following the onset of MI is a major risk. Although the mechanism behind such complications following thrombolytic agents is not clear, it is suggested that recanalization with medical thrombolysis may lead to microvascular hemorrhage, interstitial edema and contraction band necrosis as well as to a decrease in fibrinogen and elongated partial thromboplastin times especially with the usage of t-PA [2–4]. At our institution, we have been faced with one post-MI VSD and another intracranial bleeding in two female patients aged 74 and 78 years who underwent thrombolytic therapy at 12 and 18 h of the onset of symptoms for the left anterior descending coronary artery occlusion related acute MI. Both patients were managed accordingly and successfully (unpublished data). Since then we prefer to use mechanical recanalization in every particular case when it is possible. Medical revascularization is seldomly favoured and is done mostly in younger age group male patients. In order to better study the risks of such complications, it would be more appropriate if the authors could give detailed information about the blood pressure of the patient on admission and at the time of the intervention. Additionally, what was the time interval between the diagnosis and the initiation of the thrombolytic therapy? We would like to congratulate the authors for their successful management [1] in such a challenging case. References1 , , , . Post-infarct ventricular septal defect following thrombolytic intracranial bleed , Interact CardioVasc Thorac Surg , 2009 , vol. 8 (pg. 379 - 381 ) 2 , , , , . Use of thrombolytic therapy for acute myocardial infarction: effects of gender and age on treatment rates , J Thromb Thrombolysis , 2002 , vol. 13 (pg. 21 - 26 ) 3 , , , , , , . Thrombolytic therapy for women with myocardial infarction: is there a gender gap? Thrombolysis and Angioplasty in Myocardial Infarction Study Group , J Am Coll Cardiol , 1993 , vol. 22 (pg. 1780 - 1787 ) 4 , . Outcomes of thrombolytic therapy for acute myocardial infarction in women , Prog Cardiovasc Dis , 2004 , vol. 47 (pg. 58 - 71 ) Published by European Association for Cardio-Thoracic Surgery. All rights reserved. Published by European Association for Cardio-Thoracic Surgery. All rights reserved. What are the risks of thrombolysis?Despite its benefits, there is a risk that thrombolysis can cause bleeding in your brain. This happens to about one in 25 people within seven days of thrombolysis, and this can be fatal in about one in 40 cases. The sooner you are treated, the better the chances of improvement, and the lower the risk of harm.
What is the most serious complication of thrombolytic therapy?Intracranial hemorrhage, the most devastating complication, occurs in 0.2-1% of patients treated with thrombolytic therapy.
What is the major side effect of thrombolytics?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.
When should thrombolytic therapy not be used?Absolute Contraindications for Thrombolytic Treatment. Recent intracranial hemorrhage (ICH). Structural cerebral vascular lesion.. Intracranial neoplasm.. Ischemic stroke within three months.. Possible aortic dissection.. Active bleeding or bleeding diathesis (excluding menses). |
