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Lahey Health is now part of Beth Israel Lahey Health

by EBSCO Medical Review Board

Definition

Recombinant tissue plasminogen activator (tPA) treatment delivers medicine into the body to break up blood clots.

Reasons for Procedure

Blood clots can block the flow of blood. This can lead to severe damage of nearby tissue. A clot in the heart can cause a heart attack and one in the brain can cause a stroke.

tPA can break apart the blood clot to quickly improve blood flow. This can reduce or prevent damage to tissue. It is a common treatment step for:

  • Ischemic stroke
  • Heart attack
  • Pulmonary embolism—clot in lungs
  • Clots on artificial heart valves of pregnant women
  • Clots in tubing of a central venous catheter

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:

  • Excess bleeding
  • Stroke
  • Heart rhythm changes
  • Fluid buildup in the heart and lungs

Things that may raise the risk of problems are:

  • Smoking
  • Drinking alcohol
  • Chronic diseases, such as diabetes or obesity

What to Expect

Prior to Procedure

This medicine is used in an emergency. Tests will be done to find the cause of symptoms. If a stroke is suspected, treatment will be started right away. It is most effective when it is given a few hours after symptoms start.

Anesthesia

Anesthesia is not needed if tPA is given by IV.

Anesthesia will be needed if the medicine is delivered to the clot with a catheter. Options are:

Description of the Procedure

There are two ways to deliver this medicine:

IV

A bag with tPA is hung nearby. A needle is placed into a vein in the hand or arm. The medicine will drip slowly from the bag, through a tube, and into the vein. Blood flow will carry the medicine to the clot.

Catheter-directed Thrombolysis

Catheter-directed thrombolysis may be needed for people who have a problem taking tPA by IV or for very large clots. An incision will be made. A tube is inserted into a large blood vessel. The tube is passed through blood vessels to the clot. tPA is passed through the tube right to the clot. It is given in steady doses until the clot breaks up. It may take a few hours to a few days. The tube is removed. A bandage is placed over the area.

How Long Will It Take?

The IV can take several hours. The catheter-directed thrombosis may take up to 1 hour.

Will It Hurt?

There may be some discomfort at the treatment site. It will fade over the next few days.

Average Hospital Stay

The length of your stay will depend on the reason you need tPA.

Post-procedure Care

At the Hospital

During your stay, the hospital staff will take steps to lower your risk of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping any incision covered

There are also steps you can take to lower your risk of infection, such as:

  • Washing your hands often and reminding visitors and staff to do the same
  • Reminding staff to wear gloves or masks
  • Not letting others touch any incision you have
At Home

It will take a few days to fully heal. Physical activity may need to be limited during this time. Full recovery time depends on the cause of the clot.

Call Your Doctor

Call the doctor if you are not getting better or you have:

  • Vomiting
  • Bleeding
  • Sudden headache
  • Weakness on one side of the body
  • Seizure
  • Loss of alertness

If you think you have an emergency, call for medical help right away.

RESOURCES

American Heart Association  http://www.heart.org 

Society for Vascular Surgery  https://vascular.org 

CANADIAN RESOURCES

Heart and Stroke Foundation of Canada  http://www.heartandstroke.ca 

Public Health Agency of Canada  https://www.canada.ca 

References

Alteplase, recombinant (activase, cathflo activase). EBSCO Nursing Center Reference website. Available at: https://www.ebscohost.com/nursing/products/nursing-reference-center. Accessed July 22, 2021.

Catheter-directed thrombolysis. Radiology Info—Radiological Society of North America website. Available at: https://www.radiologyinfo.org/en/info/thrombo. Accessed July 21, 2021.

Ischemic stroke treatment. American Stroke Association website. Available at: https://www.stroke.org/en/about-stroke/types-of-stroke/ischemic-stroke-clots/ischemic-stroke-treatment. Accessed July 21, 2021.

Thrombolytics for acute stroke. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/thrombolytics-for-acute-stroke. Accessed July 21, 2021.

Thrombolytics for ST-elevation myocardial infarction (STEMI). EBSCO DynaMed website. Available at: https://www.dynamed.com/management/thrombolytics-for-st-elevation-myocardial-infarction-stemi. Accessed July 22, 2021.

Revision Information

  • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
  • Review Date: 07/2021
  • Update Date: 07/22/2021