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Definition

Recombinant tissue plasminogen activator (tPA) is a type of medicine. It can 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, while one in the brain can cause a stroke.

tPA can break apart the blood clot fast 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. Your doctor will go over some possible problems such as:

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

The risk of problems is higher if you:

  • Smoke
  • Drink alcohol
  • Have long term disease such as diabetes or obesity

What to Expect

Prior to Procedure

This medicine may be used in an emergency. Your care team will quickly work to find a cause of your symptoms. If a problem like stroke is suspected, treatment will begin immediately. Treatment is most effective within a few hours of the start of symptoms.

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 will then include:

  • Local anesthesia—An area will be numbed. You will be awake but won’t feel pain.
  • General anesthesia—You will be asleep.

Description of the Procedure

There are 2 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 thrombosis

May be needed for people who have a problem taking tPA by IV or for very large clots. 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 for a few hours to a few days. Once the clot is gone, the tube is removed. The cut is bandaged.

How Long Will It Take?

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

How Much Will It Hurt?

There may be some discomfort at the injection 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

The care team will track your vital signs.

At Home

Recovery time depends on injury caused by the clot.

Call Your Doctor

Call your doctor if you are not getting better or have problem such as:

  • Bleeding:
    • From nose or gums
    • In urine
    • From vagina
    • From rectum
    • Under the skin on your back—may look like a bruise
  • Sudden headache
  • Vomiting
  • Seizure
  • Loss of consciousness
  • Weakness on one side of the body

If you think you have an emergency, call for emergency medical services 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. Updated February 9, 2018. Accessed May 15, 2019.

Catheter-directed thrombolysis. Radiology Info—Radiological Society of North America website. Available at: https://www.radiologyinfo.org/en/info.cfm?pg=thrombo. Updated July 16, 2018. Accessed May 15, 2019.

Ischemic stroke treatment. American Stroke Association website. Available at: https://www.strokeassociation.org/en/about-stroke/treatment/ischemic-stroke-treatment. Accessed May 15, 2019.

Ozkan M, Cakal B, Karakoyun S, et al. Thrombolytic therapy for the treatment of prosthetic heart valve thrombosis in pregnancy with low-dose, slow infusion of tissue-type plasminogen activator. Circulation. 2013;128(5):532-540.

Thrombolytics for acute stroke. EBSCO DynaMed website. Available at:  https://www.dynamed.com/topics/dmp~AN~T114577/Thrombolytics-for-acute-stroke . Updated March 5, 2018. Accessed May 15, 2019.

Thrombolytics for ST-elevation myocardial infarction (STEMI). EBSCO DynaMed website. Available at:  https://www.dynamed.com/topics/dmp~AN~T115702/Thrombolytics-for-ST-elevation-myocardial-infarction-STEMI . Updated December 21, 2017. Accessed May 15, 2019.

Revision Information

  • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
  • Review Date: 05/2019
  • Update Date: 09/27/2019