Thrombolytic Therapy
Emergency Clot Busting Drugs

tissue plasminogen activator (tPA)

Emergency Treatment after Heart Attack

Thrombolytic Therapy

Contents

What Is Thrombolytic Therapy?
Thrombolytics For Heart Attack Patients
Thrombolytics For Stroke Patients
How Women Miss Out
Are There Any Complications Or Risks?


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Heart Disease in Women

Related Articles:

What is blood?
How does blood clot?

What Is Thrombolytic Therapy?

Thrombolytic therapy is the use of thrombolytic agents or drugs to dissolve or break up blood clots in the arteries. This results in restored blood flow to the heart. The use of clot busters has substantially reduced disability and death resulting from stroke and heart attacks in women and men. The most commonly used medication is called tissue plasminogen activator (tPA), brand names: Activase and Retavase as well as a newer drug called TNKase. Other types of clot busters like urokinase and strepkokinase, do much the same thing. According to guidelines by the American Heart Association (AHA) you have a better chance of surviving and recovering from a heart attack or stroke if you receive thrombolytic therapy within 12 hours of diagnosis (a diagnosis being based on symptoms or electrocardiogram (ECG/EKG) results). Ideally if you reach hospital in time, the drugs should be given within a 30-90 minute timeframe. If too much time passes, the damage to the heart tissue is already done, so restoring blood flow will not revive it. Thrombolytics are administered intravenously, which means they are injected via an IV line. The alternative first line treatment of choice is an emergency heart angioplasty, a surgical procedure to widen the arteries. However not all hospitals have suitable facilities (a catheterization lab) or skilled enough doctors for this operation, and transferring a patient to a suitable location would mean losing critical time. Angioplasty, also known as balloon angioplasty or stenting can however always be performed later for a more permanent solution - or coronary bypass surgery may be more appropriate.

Thrombolytics For Heart Attack Patients

If a blood clot forms in one of the arteries that supply the heart, this leads to a heart attack. The part of the heart muscle affected will be starved of oxygen and the longer it is starved the more likely it is to die and loose function. Clot busters work by dissolving the clot quickly so that blood flow can be restored and the tissue can be saved. The quicker the response, the more tissue that will be saved. Aspirin therapy will also be administered. This treatment may not restore full flow through the arteries so cardiac catheterization or angioplasty may still be needed later. The decision whether or not to give thrombolytics is usually based on the results of an ECG. Some of the following heart attack patients may not be considered candidates:

• If it has been 12 hours or more since the heart attack occurred. The window of opportunity is lost.
• Pregnant women (read about heart disease in pregnant women).
• Those who have been given prolonged CPR.
• If the patient has experienced recent trauma (particularly a head injury) or invasive surgery.
• Those with active peptic ulcers.
• Patients who take anticoagulant drugs (blood thinners such as Coumadin).
• Those with a history of stroke.
• People with uncontrolled hypertension (high blood pressure), particularly if systolic is higher than 180 mm Hg.
• Patients with low ST segments as recorded by the ECG.
• Patients older than 75 years.

Thrombolytics For Stroke Patients

Most strokes occur when a blood clot moves into a blood vessel which supplies blood to the brain. This is known as an ischemic stroke. Thrombolytics help by dissolving the clot quickly so that blood flow can be restored. Ideally, to help limit the amount of damage and disability it causes, therapy needs to be given within 3 hours. The decision whether or not to give thrombolytics will be based on the results of a brain CT scan (to make sure there is no bleeding) and physical examination. Clot busters should never be given to patients experiencing a hemorrhagic stroke because it could worsen the situation by causing more bleeding. See also: Stroke in Women.

How Women Miss Out

Many studies show that despite the benefits of clot-busting drugs, women are less likely to receive these life-saving medications than men. According to the a survey by the AHA, women who have heart attacks tend to wait longer before going to ER and when they do arrive, hospital staff take longer to administer thrombolytic therapy or do not administer it at all. Part of the reason why women arrive to ER later is that they are less likely to recognize they are having displaying heart attack symptoms. Very often women experience milder symptoms than men, in fact nearly 33 percent experience no chest pain, one of the more classic signs. Yet when they do arrive in hospital, they tend not to receive optimal medical attention. A study carried out by the State of Washington into this area found that 39 percent of women who were screened in ER for thrombolytic therapy were rejected because they were considered too old (although there are no definite guidelines to an age limit). It also found that 59 percent had nondiagnostic ECG results, meaning that a specific pattern to make them eligible for therapy was not found. A further 30 percent arrived too late for the drugs to be effective. Overall, it found that only 16 percent of women screened were considered eligible compared to 25 percent of men. And of those women considered eligible, only 55 percent received drugs, compared to 78 percent of eligible men.

Other studies show that women who do receive thrombolytic agents have a 12 percent reduced risk of dying of another heart attack within 35 days of treatment. The benefit to men is slightly less. However, women who are treated have significantly higher risks of dying of stroke compared to men. The reason for this is not clear.

Know Your Risk: Risk Factors For Heart Disease.

Are There Any Complications Or Risks?

Thrombolytics were first used in the 1960s and 1970s but were abandoned because studies showed they caused intracranial bleeding (bleeding in the brain). It is only recently that interest was restored in this line of treatment with the introduction of more effective, safer drugs. Hemorrhagic stroke or bleeding is still the most serious complication with thrombolytics. But fortunately, with newer drugs, this is an extremely rare occurrence (less than 1 percent, risk is the same for heart attack and stroke patients). Minor side effects such as bleeding in the nose or gums affect about 25 percent of those who receive the drugs.

After a Stroke or Heart Attack:
Read about living with heart disease and cardiac rehabilitation.

  Related Articles on Clot Busting Medications

For more general treatment advice, see the following:

Coronary Heart Disease Treatment
Heart Attack Treatment

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