This is an incredible group of drugs, thrombolytics.
Lytic means, right blow it up, thrombus means clot.
So, these are some bad yet really good drugs.
Alteplase is another one, we call it TPA.
We use these as an emergency treatment to dissolve diagnosed clots.
So, if the patients rolls in the ER, they're having an MI, we've got them in the cath lab.
We know they've got a clot. This is a drug, an example of one of them that we can use.
We don’t use this for prevention. You don’t go home on thrombolytics.
This is an acute treatment for someone that we know has a clot.
Usually used in the heart, also can be used for clots in the brain,
because tPA converts plasminogen to plasmin, and plasmin is that enzyme that dissolves clots.
Remember, it dissolves the fibrin matrix of blood clots. So, just stop for a minute.
One of the most dramatic stories I remember with this is I was in California.
And we had a young mother come in, who's a single mother of children.
She had a left-sided stroke. She was completely paralyzed on the left side of her body.
She appropriately received a thrombolytic, and walked out of that hospital without any residual.
It gives me goosebumps just thinking about it. So, when this drug works, it’s a miracle.
But I also remember a patient that I will never forget who was the sole breadwinner for a very large extended family.
He came in with an MI, we ran all the screenings, did everything that we could and he had a completely different result.
He ended up with a major bleed in his head and did not survive that hospital stay.
I won’t ever forget the sounds of that family as they grieved the passing of this patriarch of their family.
So, when these drugs worked, they’re a miracle, but they come at a very high risk.
So, you wanna be very careful when you’re a part of the health care team
and you helped asses this patient for the risk factors.
So, let’s talk about some of those special precautions.
Even when you follow this list, to the letter, your patient is still at risk.
There is a significant risk for life-threatening bleeding because it dissolves all of the clots.
He clearly had something in his head that was supposed to be there
and when we get in thrombolytic treatment, it burst open.
So, intracranial bleeding, that’s usually the biggest risk.
So, you wanna screen your patients very, very carefully before you give them a thrombolytic.
If they have a platelet disorder, coagulopathy disorders or history of stroke, recent surgery.
Remember, ask yourself why.
Why would it be difficult or wrong or unsafe to get a med that lysis every clot if you have a platelet disorder?
If already of clotting problems, a thrombolytic is just gonna intensify those.
Same thing with coagulopathy, you have a history of a stroke
that puts you on an increased risk for maybe delving a head bleed.
So, all these factors need to be evaluated by an expert health care team
before your patient can receive this medication at the safest level possible.
Now, we want you to get any medication early on, on the process
but there's a special note here about thrombolytics.
Underlying onset of symptoms. See, here’s the deal.
There’s a really tight window and most places are at 4 hours maybe even up to 6.
Earlier is better, but at least with 4 to 6-hour window of when the patient experience the symptoms.
Why would that be? Well, we're not trying to be difficult, but because this is a high-risk drug.
Remember, we have some really serious outcomes with this.
It’s a high-risk drug, you wanna make sure that the tissue on the other end of that clot is still viable.
We can get it into it in that 4-hour window.
Then we have a chance of restoring blood flow tissue that can regenerate itself.
If it’s after that 6-hour window, there’s no reason to take the risk of a thrombolytic
for tissue that likely even if we reperfuse it, it’s not gonna be come back and be viable.
So, watch your patient very closely, who receives a thrombolytic for any signs of bleeding, keep them safe,
don’t let them fall, don’t let them get up without you, minimize any risk for tissue trauma.
So, you want their bed rails up, you wanna watch them closely.
Sometimes, we would be even put pads on the bed rails so they wouldn’t bump an elbow or an arm on the bed.
This patient's gonna need extended time to stop bleeding after simple things, like a finger stick blood sugar or a lab.
Just plan time on your care, that you’re gonna have to hold pressure on that little tiny wound for a long period of time.