Thrombolytic (fibrinolytic) Therapy in Acute Myocardial Infarction

What is thrombosis and what is a thrombus?

Thrombosis is an important part of the normal hemostatic response that limits hemorrhage caused by microscopic or macroscopic vascular injury. Physiologic thrombosis is counterbalanced by intrinsic antithrombotic properties and fibrinolysis. Under normal conditions, a thrombus is confined to the immediate area of injury and does not obstruct flow to critical areas, unless the blood vessel lumen is already diminished, as it is in atherosclerosis.  Under pathologic conditions, a thrombus can propagate into otherwise normal vessels. A thrombus that has propagated where it is not needed can obstruct flow in critical vessels; it can also obliterate valves and other structures that are essential to normal hemodynamic function

‍

What kinds of patients will need thrombolytic therapy?

Thrombolytic therapy may be indicated in patients who have:  

-Blocked arteries of the brain (stroke).  

-Blocked arteries of the heart (heart attack).  

-Blocked arteries of the lung (pulmonary embolism).  

-Blocked veins of the leg (deep vein thrombosis/DVT).  

-Blocked arteries of the leg (acute arterial thrombosis /leg ischemia).  

-Blocked surgical bypasses, blocked dialysis fistulas or catheters.

‍

What is the prognosis after thrombolytic therapy?

Although thrombolysis is usually successful, the treatment is not able to dissolve the blood clot in up to 25% of patients. Another 12% of patients subsequently redevelop the clot or blockage in the blood vessel.  In addition, thrombolysis alone -- even when successful -- cannot treat tissue that has already been damaged by compromised blood circulation. So, further treatment may be needed to address the underlying causes of the blood clot and repair damaged tissues and organs.