Information for patients undergoing thrombolysis

This leaflet tells you about the procedure known as thrombolysis; it explains what is involved and what the possible risks are. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. Whether you are having the thrombolysis as a planned or an emergency procedure, you should have sufficient explanation before you sign the consent form. What is thrombolysis? Thrombolysis means breaking up blood clots. Once a clot starts to form in a blood vessel, it may carry on getting bigger until the whole vessel is blocked. While an operation may be necessary to remove the clot, it is also possible to dissolve the clot by injecting a special clotbusting drug into the artery, directly into the clot. This can lead to a great improvement in blood flow, and make an operation unnecessary. Why do I need thrombolysis? Your doctors know that there is a problem with part of your circulation. You are likely to have had an angiogram, a special x-ray examination of the blood vessels, which has shown a blockage in an

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artery. If nothing is done about the situation, then severe and permanent damage will result, and amputation may be necessary. While the blockage could need treatment with surgery, in your case it has been decided that thrombolysis is the best way of proceeding. Who has made the decision? The doctors in charge of your case, and the radiologist doing the thrombolysis, will have discussed the situation, and feel that this is the best treatment option. However, you will also have the opportunity for your opinion to be considered, and if, after discussion with your doctors, you do not want the procedure carried out, you can decide against it. Who will be doing the thrombolysis? A specially trained doctor called a radiologist. Radiologists have special expertise in using x-ray equipment, and also in interpreting the images produced. They need to look at these images while carrying out the procedure.

What are the risks and complications? Thrombolysis is a very safe procedure, but there are some risks and complications that can arise. There may occasionally be a small bruise or haematoma around the site where the needle has been inserted, and this is quite normal. If this becomes a large bruise, then there is the risk of it getting infected, and this would then require treatment with antibiotics. Very rarely, some damage can be caused to the artery by the catheter and this may need to be treated by surgery or another radiological procedure. Clot-busting drugs have to be very powerful in order to work, and consequently there is a risk that bleeding will occur elsewhere. For example, if you have a duodenal ulcer, it is possible that this might start bleeding. If this happened, it would be necessary to treat it in the usual way, perhaps with a blood transfusion. However, the risks associated with not treating your blocked artery are felt to be greater than the risks of bleeding elsewhere. Sometimes the blood clot may be so extensive that the clot-busting drug simply cannot dissolve it all away. In these cases, it may be that surgery will be required to relieve the blockage. Despite these possible complications, the procedure is normally very safe, and is carried out with no significant side-effects at all.

Where will the procedure take place? Generally in the x-ray department, in a special screening room, which is adapted for specialised procedures. How do I prepare for thrombolysis? You need to be an inpatient in the hospital. You will probably be asked not to eat for four hours beforehand, though you may be allowed to drink some water. You may receive a sedative to relieve anxiety. You will be asked to put on a hospital gown. As the procedure is generally carried out using the big artery in the groin, you may be asked to shave this area. If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium (the dye used for kidney x-rays and CT scans), then you must also tell your doctor about this. What actually happens during thrombolysis? The procedure starts off in exactly the same way as an angiogram, and if you have already had this performed, you will know what to expect. You will lie on the x-ray table, generally flat on your back. Once the radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle, and into the artery. Then the needle is withdrawn allowing the small plastic tube, or catheter, to be placed over the wire and into the artery. The radiologist will use the x-ray equipment, and small amounts of contrast medium to make sure that the catheter, still on the wire, is moved into the right position, very close to the blockage in the artery. Then the wire will be The radiologist needs to keep everything as sterile as possible, and may wear a theatre gown and operating gloves. The skin near the puncture site, probably the groin, will be swabbed with antiseptic, and then the rest of your body covered with a theatre towel. The skin and deeper tissues over the artery will be anaesthetised with local anaesthetic, and then a needle will be inserted into the artery. You need to have a needle put into a vein in your arm, so that the radiologist can give you a sedative or painkillers. Once in place, this needle will not cause any pain. You may also have a monitoring device attached to your chest and finger, and may be given oxygen through small tubes in your nose.

withdrawn and the clot-busting, or thrombolytic, drug injected down the catheter and into the blood clot. The radiologist will check progress by injecting contrast to show how much the clot has dissolved. Although sometimes all the clot is dissolved at the first attempt, generally the catheter has to be left in the artery attached to an infusion pump, so that injection of the clot-busting drug can be continued over the next few hours, or days. Will it hurt? Some discomfort may be felt in the skin and deeper tissues during injection of the local anaesthetic. After this, the procedure should not be painful. The radiologist and other staff looking after you can give you additional painkillers through the needle in your arm, if necessary. You will be awake during the procedure, and able to tell the radiologist if you feel any pain, or become uncomfortable in any other way. As the dye, or contrast medium, passes around your body, you may get a warm feeling, which some people can find a little unpleasant. However, this soon passes off and should not concern you.

How long will it take? Every patients situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Sometimes thrombolysis does not take very long, perhaps half an hour. On other occasions the procedure may be more involved, and take rather longer, perhaps over an hour. As a guide, expect to be in the x-ray department for about an hour and a half. What happens afterwards? You will be taken back to your ward on a trolley. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no untoward effects. They will also look at the puncture site to make sure there is no bleeding from it. You need to stay in bed for as long as the catheter stays in the artery. The radiologist needs to check on progress, and will arrange for you to come back to the x-ray department the next day, or the day after. By injecting a small amount of contrast medium, or dye into the catheter it is possible to tell how much of the clot has dissolved. The radiologist may also use a special balloon, on a different catheter, to try and open up a narrowed artery, and improve blood flow even more.

involved, and although it is difficult to say exactly how often these What happens next? This all depends on where the blockage was, and how successful the thrombolysis has been. In many cases, no further procedure is necessary. In some cases the artery may be so narrowed that an operation is required to permanently improve the blood supply. Most patients will be started on aspirin, or blood-thinning drugs, anticoagulants, to improve blood flow in their arteries, and to try and limit the chance of a similar condition occurring again. Finally... Some of your questions should have been answered by this leaflet, but remember this is only a starting point for discussion about your treatment with the doctors looking after you. Do satisfy yourself that you have received enough information about the procedure, before you sign the consent form. Thrombolysis is considered a very safe procedure, designed to improve your medical condition and save you having a larger operation. There are some slight risks and possible complications
Legal notice Please remember that this leaflet is intended as general information only. It is not definitive, and The Royal College of Radiologists and the British Society of Interventional Radiology cannot accept any legal liability arising from its use. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please therefore always check specific advice on the procedure or any concerns you may have with your doctor. This leaflet has been prepared by the British Society of Interventional Radiology (BSIR) and the Clinical Radiology Patients Liaison Group (CRPLG) of The Royal College of Radiologists. Board of the Faculty of Clinical Radiology The Royal College of Radiologists, March 2008

occur, they are generally minor and do not happen very often.
Other sources of information Websites For general information about radiology departments, visit The Royal College of Radiologists website: www.goingfora.com NHS Direct For health advice or information you can call NHS Direct on 0845 45647 or visit the website: www.nhsdirect.nhs.uk
The Royal College of Radiologists, May 2008. Permission is granted to modify and/or reproduce this leaflet for purposes relating to the improvement of healthcare, provided that the source is acknowledged and that none of the material is used for commercial gain. The material may not be used for any other purpose without prior consent from The Royal College of Radiologists.

Notes for medical staff This patient information leaflet may be downloaded and, if necessary adapted, for medical use and is also a direct source of information for patients accessing this website. It has been produced by the Clinical Radiology Patients Liaison Group of The Royal College of Radiologists. If

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