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 people
- 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:
What to Expect
Prior to Procedure
This medicine is used in an emergency. Tests will be done to find the cause of symptoms. Treatment will be started right away if a stroke is suspected. 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:
- Local anesthesia—the area will be numbed
- General anesthesia—you will be asleep
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
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
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.
Problems To Look Out For
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 April 15, 2022.
Catheter-directed thrombolysis. Radiology Info—Radiological Society of North America website. Available at: https://www.radiologyinfo.org/en/info/thrombo. Accessed April 15, 2022.
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 April 15, 2022.
Thrombolytics for acute stroke. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/thrombolytics-for-acute-stroke. Accessed April 15, 2022.
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 April 15, 2022.
Revision Information
- Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
- Review Date: 03/2022
- Update Date: 04/15/2022