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Cardiac Thrombolysis

AMBULATORY CARE:

What you need to know about cardiac thrombolysis:

Cardiac thrombolysis is a procedure to dissolve or break up a blood clot near your heart. The clot may be removed with a device during the procedure. A clot that forms in the arteries or chambers of the heart can cause a heart attack. The clot can cause a stroke if it breaks off and travels to your brain. Thrombolysis needs to be done as quickly as possible to prevent heart damage or a stroke.


How to prepare for the procedure:

  • Your healthcare provider will tell you how to prepare for your procedure. He may tell you not to eat or drink anything after midnight on the day of your procedure. He will tell you what medicines to take or not take on the day of your procedure. Arrange to have someone drive you home when you leave the hospital.
  • You may be given contrast liquid before or during the procedure to help the clot show up in pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. You may need blood tests and a stress test before your procedure. Talk to your healthcare provider about these or other tests you may need.

What will happen during the procedure:

  • You may be given an antibiotic to help prevent an infection caused by bacteria. You may be given local anesthesia to numb the procedure site. Your healthcare provider may choose a vein or artery in your leg, arm, elbow, groin, or neck. With local anesthesia, you may still feel pressure or pushing, but you should not feel any pain. You may instead be given general anesthesia to keep you asleep and free from pain. Your healthcare provider will inject medicine into your IV that will help dissolve or break up the clot. It is most often given into a vein, but it may be given into an artery. If the medicine is given into an artery, a catheter is guided by x-ray so it is near the blood clot.
  • Your heart rate and blood pressure will be monitored. If you have local anesthesia, healthcare providers may also frequently check your neurological (neuro) status. Your neuro status will be checked to see how well your brain is working. Healthcare providers may check your eyes, your memory, and your hand grasp.

What will happen after the procedure:

Healthcare providers will apply pressure on the procedure site to stop any bleeding. You will be monitored closely for any problems. Do not get out of bed until your healthcare provider says it is okay. You will then be taken to your hospital room.

  • You will need to walk around the same day of your procedure, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your healthcare provider says you can. Ask before you get up the first time. You may need help to stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call button to let someone know you need help.
  • Medicines:
    • Anticoagulants are a type of blood thinner medicine that helps prevent clots. Anticoagulants may cause you to bleed or bruise more easily.
    • Antiplatelets help prevent blood clots. This medicine makes it more likely for you to bleed or bruise.

Risks of cardiac thrombolysis:

Thrombolysis increases your risk for bleeding. You may have increased nosebleeds or bleeding from your gums. You may also have bleeding in your stomach or brain. Bleeding can become severe and life-threatening. If the clot is removed, the device used may cause an irregular heartbeat. You may also have an allergic reaction to the contrast liquid or to the medicine used to break up the clot.

Call 911 for any of the following:

  • You have any of the following signs of a heart attack:
    • Squeezing, pressure, or pain in your chest that lasts longer than 5 minutes or returns
    • Discomfort or pain in your back, neck, jaw, stomach, or arm
    • Trouble breathing
    • Nausea or vomiting
    • Lightheadedness or a sudden cold sweat, especially with chest pain or trouble breathing
  • You have any of the following signs of a stroke:
    • Numbness or drooping on one side of your face
    • Weakness in an arm or leg
    • Confusion or difficulty speaking
    • Dizziness, a severe headache, or vision loss

Seek care immediately if:

  • Your heart is beating faster than usual.
  • Your wound does not stop bleeding even after you apply firm pressure for 10 minutes.
  • The procedure site is numb, painful, or changes color.
  • You see blood in your urine.
  • The bruise at your catheter site gets bigger or becomes swollen.
  • You have purple spots or blisters on your skin.

Contact your healthcare provider if:

  • You have a fever.
  • You have a new skin rash and itching.
  • You feel weak, lightheaded, or faint.
  • You have new swelling around your eyes.
  • You have questions or concerns about your condition or care.

Medicines:

  • Antiplatelets , such as aspirin, help prevent blood clots. Take your antiplatelet medicine exactly as directed. These medicines make it more likely for you to bleed or bruise. If you are told to take aspirin, do not take acetaminophen or ibuprofen instead.
  • Blood thinners help prevent blood clots. Examples of blood thinners include heparin and warfarin. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
    • Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
    • Tell your dentist and other healthcare providers that you take anticoagulants. Wear a bracelet or necklace that says you take this medicine.
    • Do not start or stop any medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
    • Tell your healthcare provider right away if you forget to take the medicine, or if you take too much.
    • Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin.
      • Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
      • You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Wound care:

Keep your wound clean and dry. Ask your healthcare provider when you can bathe. You will need to keep the bandage in place and dry for a day or two after your procedure. Cover the bandage with a plastic bag and tape the opening around your skin to keep water out. When you are allowed to bathe without a bandage, carefully wash the wound with soap and water. Check the wound daily for signs of infection, such as redness, swelling, or pus. Dry the area and put on new, clean bandages as directed. Change your bandage if it gets wet or dirty.

Watch for bleeding and bruising:

It is normal to have a bruise and soreness where the catheter went in. Contact your healthcare provider if your bruise gets larger. If your wound bleeds, use your hand to put pressure on the bandage. If you do not have a bandage, use a clean cloth to put pressure over and just above the puncture site. Seek care immediately if the bleeding does not stop within 10 minutes.

Do not lift heavy objects after your procedure:

Your healthcare provider or cardiologist may tell you not to lift anything heavier than 10 pounds. For example, a gallon of milk weighs 8 pounds. Ask how much weight is safe for you to lift. You may need to be careful for a few weeks after your procedure.

Go to cardiac rehabilitation (rehab) as directed:

Cardiac rehab is a program run by specialists. You will learn to strengthen your heart safely and prevent more heart disease or another blood clot. The program includes exercise, relaxation, stress management, and heart-healthy nutrition. Healthcare providers will also check to make sure any medicines you are taking are working. The program may also include instructions for when you can drive, return to work, and do other normal daily activities.

Prevent another blood clot:

  • Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause blood vessel and lung damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
  • Drink liquids as directed. Liquids will help flush out the contrast material used during your procedure. Liquid can also help prevent blood clots. Ask your healthcare provider how much liquid to drink each day and which liquids are best for you.
  • Stay active. Go slowly at first. Then increase your activity. An active lifestyle can help prevent blood clots. Try to get at least 30 minutes of activity on most days of the week. If you sit most of the day for work, stand or walk around every half hour. After an injury or illness, try to become active again as soon as possible. Activity can also help you manage your weight. Overweight or obesity can increases your risk for another blood clot.
  • Manage other health conditions. Follow your healthcare provider's directions to manage health conditions that can cause a blood clot. Examples are high cholesterol and diabetes.
  • Limit alcohol. Do not drink alcohol for 24 hours after your procedure. Then limit alcohol. Women should limit alcohol to 1 drink a day. Men should limit alcohol to 2 drinks a day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.

Follow up with your healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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