Alteplase (tPA) – Thrombolytics (Nursing)

00:00 This is an incredible group of drugs, thrombolytics.

00:04 Lytic means, right blow it up, thrombus means clot.

00:08 So, these are some bad yet really good drugs.

00:12 Alteplase is another one, we call it TPA.

00:15 We use these as an emergency treatment to dissolve diagnosed clots.

00:20 So, if the patients rolls in the ER, they're having an MI, we've got them in the cath lab.

00:24 We know they've got a clot. This is a drug, an example of one of them that we can use.

00:30 We don’t use this for prevention. You don’t go home on thrombolytics.

00:34 This is an acute treatment for someone that we know has a clot.

00:38 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.

00:50 Remember, it dissolves the fibrin matrix of blood clots. So, just stop for a minute.

00:55 One of the most dramatic stories I remember with this is I was in California.

00:59 And we had a young mother come in, who's a single mother of children.

01:03 She had a left-sided stroke. She was completely paralyzed on the left side of her body.

01:07 She appropriately received a thrombolytic, and walked out of that hospital without any residual.

01:14 It gives me goosebumps just thinking about it. So, when this drug works, it’s a miracle.

01:21 But I also remember a patient that I will never forget who was the sole breadwinner for a very large extended family.

01:29 He came in with an MI, we ran all the screenings, did everything that we could and he had a completely different result.

01:37 He ended up with a major bleed in his head and did not survive that hospital stay.

01:42 I won’t ever forget the sounds of that family as they grieved the passing of this patriarch of their family.

01:49 So, when these drugs worked, they’re a miracle, but they come at a very high risk.

01:56 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.

02:03 So, let’s talk about some of those special precautions.

02:06 Even when you follow this list, to the letter, your patient is still at risk.

02:11 There is a significant risk for life-threatening bleeding because it dissolves all of the clots.

02:18 He clearly had something in his head that was supposed to be there and when we get in thrombolytic treatment, it burst open.

02:25 So, intracranial bleeding, that’s usually the biggest risk.

02:30 So, you wanna screen your patients very, very carefully before you give them a thrombolytic.

02:35 If they have a platelet disorder, coagulopathy disorders or history of stroke, recent surgery.

02:41 Remember, ask yourself why.

02:43 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.

02:57 Same thing with coagulopathy, you have a history of a stroke that puts you on an increased risk for maybe developing a head bleed.

03:06 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.

03:16 Now, we want you to get any medication early on, on the process but there's a special note here about thrombolytics.

03:22 Underlying onset of symptoms. See, here’s the deal.

03:27 There’s a really tight window and most places are at 4 hours maybe even up to 6.

03:32 Earlier is better, but at least within a 4.5 hour window of when the patient experience the symptoms.

03:41 If it’s after that 4.5 hour window, there’s no reason to take the risk of a thrombolytic for tissue that, even if we reperfuse it, likely is not gonna be come back to be viable.

03:54 Why would that be? Well, we're not trying to be difficult, but because this is a high-risk drug.

03:58 Remember, we have some really serious outcomes with this.

04:02 It’s a high-risk drug, you wanna make sure that the tissue on the other end of that clot is still viable.

04:08 We can get it into it in that 4-hour window.

04:11 Then we have a chance of restoring blood flow tissue that can regenerate itself.

04:16 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.

04:27 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.

04:40 So, you want their bed rails up, you wanna watch them closely.

04:43 Sometimes, we would be even put pads on the bed rails so they wouldn’t bump an elbow or an arm on the bed.

04:49 This patient's gonna need extended time to stop bleeding after simple things, like a finger stick blood sugar or a lab.

04:57 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.