thrombolysis

(throm″bol′ĭ-sĭs)

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[thrombo- + -lysis]
The breaking up of a thrombus. Thrombolytic enzyme therapy is used for lysis of thrombi obstructing coronary arteries in acute myocardial infarction, management of acute massive pulmonary embolism, acute ischemic stroke within 3 hr of symptom onset, after intracranial bleeding has been ruled out, and to lyse deep vein thrombosis via catheter-directed delivery.
SYN: SEE: thromboclasis

PATIENT CARE
The health care provider should obtain a complete medical history before administering thrombolytic drugs. Recent surgery, trauma, invasive procedures, uncontrolled hypertension, brain tumors, a history of abnormal bleeding, or pregnancy are all contraindications to their use. In ischemic stroke, the strict time limit for use of thrombolysis is within 3 hr of initial symptoms. Thrombolysis later in the course leads to increased risk of intracranial bleeding and death. The use and administration of thrombolytic drugs should be explained to the patient and family. Each thrombolytic enzyme has specific instructions for reconstitution and dosing, and all are administered intravenously. The drugs should be given through a dedicated IV catheter and line and administered by an infusion controller. Health care professionals should be prepared to initiate anticoagulant and antiplatelet therapy as prescribed during or immediately after thrombolytic treatment to decrease the risk of rethrombosis. The patient’s vital signs, heart rhythm, and neurologic status require intensive monitoring during and after therapy. Strict bedrest is required. In patients treated for acute myocardial infarction, reperfusion-induced arrhythmias are treated as prescribed or according to Advanced Cardiac Life Support protocols. Spontaneous bleeding (cerebral, retroperitoneal, GI, and GU) may occur with thrombolysis; the patient should be assessed every 15 min initially, then every 30 min then hourly, then every 4 hr (time span for each varies with the particular drug used). Invasive procedures should be avoided; all puncture sites assessed and reassessed. Patient movement should be restricted, but when necessary, it should be performed gently. Antihistamines or corticosteroids may be used to treat mild allergic responses, but infusion should be stopped if a severe allergic response occurs. Bleeding is the most common adverse effect, occurring internally and at external puncture sites. If uncontrollable bleeding occurs, the infusion should be stopped immediately and the prescriber notified.

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