Methods and drugs for thrombolysis in myocardial infarction

If thrombolysis is successful, then the following phenomena are observed:

  1. The patient quickly decreases, and then the pain disappears.
  2. The return of electrocardiography to normal.
  3. The development of atrial fibrillation (atrial fibrillation) during thrombolytic therapy.
  4. A return to normal levels of indicators of cardiospecific biochemical markers of necrosis.

Also, during the course of thrombolysis, the general condition of the patient and other indicators of his health (heart rate, respiration, blood pressure and others) are evaluated.

To understand what it is – thrombolysis treatment, we pay attention to the components of the word. The name stands for lysis of a blood clot.

In a healthy person, special blood enzymes are involved in the destruction of a blood clot, but in a number of diseases the protective forces fail and artificial or artifact thrombolysis is required.

The need for lysis or dissolution of thrombosis occurs in the following cases:

  • a detached blood clot completely blocks the lumen of the vessel, interfering with the blood supply to the tissues;
  • the accumulation of blood clots complicates vascular blood flow.

Thrombolytic therapy is aimed at eliminating blood clots with the help of medications. Means that eliminate platelet aggregation are administered intravenously or into a thrombosed vessel.

Indications for thrombolysis with myocardial infarction are:

  • the acute period of cardiac necrosis (in the first 6 hours after the onset of the attack);
  • small focal lesions of the heart muscle, accompanied by severe pain and the appearance of the Q wave on the cardiogram (in this case, thrombolytics are administered within 12 hours after the onset of the acute phase of the heart attack);
  • severe heart rhythm disturbance;
  • acute violation of the blood supply to the heart muscle.

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contraindications

The absolute contraindications to the introduction of thrombolytics include pathological conditions, characterized by an increased risk of blood loss:

  • active bleeding (including gastrointestinal, recently transferred);
  • exacerbation of peptic ulcer of the stomach and duodenum;
  • acute nonspecific colitis;
  • acute, acute and subacute stage of hemorrhagic stroke;
  • major surgical interventions;
  • early postpartum period;
  • previous subarachnoid hemorrhages;
  • severe head injuries.

One of the most dangerous pathologies of the cardiovascular system is ischemic stroke, which requires the most effective treatment in the first hours after the onset.

One of the methods for this is thrombolysis, which is necessarily included in the treatment regimen for ischemic stroke in the early stages. This method is based on the introduction into the patient’s blood of drugs that cause blood clot destruction and improve blood composition.

Purpose of the procedure

  • Ischemic stroke is a violation of cerebral circulation with damage to the brain due to the fact that blood does not enter well or does not enter at all in one of its departments.
  • It is accompanied by a softening of part of the brain tissue (cerebral infarction).
  • The reason may be a decrease in blood flow in the vessels of the brain, thrombosis or embolism, which appear as a result of diseases of the cardiovascular system and blood.
  • Mortality from it is about 20% of the total number of patients.
  • Sometimes the name “cerebral infarction” may occur.

This method is most effective in the first hours after a stroke, at a later date it is not used. Naturally, for his appointment, there are a number of indications and contraindications.

According to the clinical protocol, thrombolytic therapy is divided into drug and mechanical.

Показания

The following indications for the use of TLT are:

  1. no more than 3 to 6 hours have passed since the onset of symptoms;
  2. on CT and MRI, the picture of ischemic stroke is clearly visible;
  3. pronounced neurological deficit, i.e. symptoms indicating damage to a portion of the brain;
  4. lack of general contraindications.

contraindications

The treatment protocol indicates such contraindications:

  • aortic dissection;
  • cerebrovascular accident in the last 2 months;
  • a major operation that was performed less than three weeks ago;
  • multiple myocardial infarction with severe cardiosclerosis;
  • aggravation of peptic ulcer disease;
  • cirrhosis of the liver;
  • glomerulonephritis;
  • hypertension, in which the pressure practically does not fall below 180/100;
  • pregnancy;
  • taking medications that reduce blood coagulability;
  • recent retinal laser therapy;
  • streptokinase allergy that has occurred over the past two years.

Important! Hemorrhagic stroke or subarachnoid hemorrhage in the last six months, any active bleeding in the last month are absolute contraindications for the procedure. Because drugs break down all blood clots, not only recently appeared.

Currently, three generations of drugs are used for thrombolysis.

The first generation is Streptokinase and Urokinase. These drugs are rarely used due to the high risk of complications after their use. Streptokinase is administered over an hour. When applying Urokinase, heparin must be administered intravenously. Both drugs are administered drip.

Important! Streptokinase is not compatible with the human body and often causes acute allergic reactions. With the use of Urokinase, this is rarely observed.

The second generation includes Aktilize (Alteplase) and Prourokinase. The first drug must be administered in the first 4 to 5 hours after a stroke. Dosage of 0,9 mg per 1 kg of patient weight, but not more than 90 mg. A tenth of the dose is administered jet, and the remainder is drip.

Prourokinase is used in the first 6 hours of the disease, but in some cases it is permissible to use it for up to 12 hours. Introduced in 3 to 6 minutes. There are two forms of drug release non-glycated and glycosylated. Glycated acts faster.

The third generation includes Metalysis (Tenecteplase), Retiplase and Anestriplase. Drugs of this generation are injected in a jet, usually it takes about 10 seconds.

The dosage of metalysis depends on the weight of the patient. Up to 60 kg – 30 mg, 80 – 90 kg – 45 mg. The effect of the drug is enhanced by Heparin and Acetylsalicylic acid (Aspirin). Retilase according to the treatment regimen is administered in two doses.

The second injection of the drug is carried out half an hour after the first. Anistreplase is a complex drug consisting of streptokinase with plasminogen, which provides a quick effect on a blood clot. Once administered, 30 units of the drug.

Reference! These drugs dissolve blood clots, but do not prevent their further formation. Most likely, the patient will be prescribed a course of drugs that reduce blood coagulation after thrombolysis.

According to international studies, the effectiveness of thrombolytic therapy for ischemic stroke depends on the time elapsed after the onset of the disease.

trombolizis pri bolezni serdtsa - Methods and drugs for thrombolysis in myocardial infarction

In general, it can be said that when such treatment is carried out for up to 4,5 hours, the improvement in the condition of patients is 30% higher than without it. The best result is achieved if treatment begins no later than three hours later.

  1. At the same time, mortality and the likelihood of irreversible brain damage leading to disability are significantly reduced.
  2. Before agreeing to such treatment, it is absolutely necessary to require CT/MRI as soon as possible, because bleeding should be excluded, and every minute of the course of the disease will be counted.

It is also necessary to tell the doctor about all the diseases of the patient for a period of two years, even if it seems insignificant. If possible, insist on therapy with the latest generation of drugs to dissolve the thrombus as quickly as possible.

The use of methods of CT (MR) angiography and/or CT (MRI) – perfusion studies is advisable if they are technically feasible without delaying the onset of IV transplantation (i.e., starting the infusion of thrombolytic in the CT room), and may be in demand outcome or beyond 4,5 hours, if in the conditions of this center endovascular treatment of ischemic stroke is available (intra-arterial thrombolysis, thromboembolectomy).

Tasks of laboratory diagnostics in patients with a presumptive diagnosis of a stroke: to determine the parameters of a clinical blood test, including obligatory before TLT (platelet count, glucose; APTT when using heparin in the previous 2 days and INR when taking warfarin before the development of this disease) Thrombolysis is carried out only in conditions of BITR (monitoring of blood pressure, heart rate, NPV, t, spo2)

The use of multimodal neuroimaging in some cases can be used to make a decision regarding patients whose exact time for the onset of a stroke is unknown, but is not recommended as a routine clinical practice.

Coronary heart disease accounts for 53% of the population mortality structure, of which 13% die from myocardial infarction, the most dangerous pathological condition requiring urgent medical intervention. In 2015, about 63 thousand people died of a heart attack in Russia.

The cause of heart pathology in the vast majority of cases is coronary artery thrombosis, due to which myocardial cells die.

For successful treatment of a heart attack, it is necessary to immediately restore coronary blood flow, since necrosis of myocardial cells develops within 4-6 hours.

In countries with a large territory and poorly developed transport infrastructure, including Russia, the implementation of PCI is difficult because most patients do not immediately go to hospitals that can provide them with the necessary therapy.

If performing percutaneous coronary intervention as soon as possible is impossible, the only alternative method for restoring blood flow is thrombolytic therapy – a treatment method consisting in the introduction of a drug that dissolves a blood clot into a blood vessel.

Indications for use in myocardial infarction

Over time, the set of clinical conditions is corrected, in which thrombolysis therapy is recommended. Currently, indications for thrombolysis in myocardial infarction are as follows:

  • the presence of an increase in the ST segment on electrocardiography, as well as other signs of acute myocardial infarction;
  • no more than 12 hours since the onset of ischemic pain;
  • first appeared complete blockade of the right leg of the bundle of His against the background of ischemic pain in the sternum.

If all these conditions are met, then the medical worker begins to carry out thrombolysis with myocardial infarction. An assessment of the possibility of carrying out this procedure should be performed at the first contact of the patient with characteristic complaints with a medical professional.

Varieties of thrombolysis

Depending on the place of administration of the preparations necessary for thrombolysis, doctors distinguish systemic and local methods. Each of the methods has disadvantages and advantages.

System

Thrombolytic drugs are injected into the vein on the elbow.

The advantages of the method are as follows:

  • general blood thinning;
  • the ability to dissolve a blood clot in an inaccessible area;
  • ease of manipulation (can be performed both in a hospital setting and as a first aid for acute thrombosis).

The disadvantages include the need to introduce drugs for thrombolysis in maximum therapeutic doses. Such a medicinal effect negatively affects the general condition of the blood.

The drugs that eliminate thrombosis are injected into the vessel where the blood clot is located.

trombolizis - Methods and drugs for thrombolysis in myocardial infarction

  • therapeutic effect is achieved in a short time;
  • there is no need for large doses of medication;
  • drugs have less effect on overall blood coagulability;
  • effective 6 hours after the cessation of blood flow to tissues.
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Selective thrombolysis has one drawback – a specially trained specialist is required to perform the intervention. The procedure is performed by a doctor, introducing a catheter under the control of an ultrasound machine.

Thrombolytic treatment is also divided into types according to the properties of the medications administered:

  • generalized (drugs with a wide spectrum of action are used);
  • selective (use drugs with a narrowly targeted effect).

Which method will be used – individually selected. The choice is influenced by the time elapsed since the moment of thrombosis, the nature of vascular disorders and many other factors.

Absolute contraindications

This procedure is considered quite complicated and is not always easily tolerated by patients. Doctors have established a list of conditions that may impede its implementation. To date, the following absolute contraindications to thrombolysis with myocardial infarction are distinguished:

  1. The presence of a stratified aortic aneurysm.
  2. A history of hemorrhagic stroke less than 6 months ago.
  3. Violations of the blood coagulation system.
  4. Arterial hypertension resistant to antihypertensive therapy (with the help of drugs it is not possible to reduce the level of systolic blood pressure below 220 mm Hg, and diastolic below 110 mm Hg).
  5. Surgery less than 3 weeks ago.
  6. Gastrointestinal bleeding less than 1 month ago.
  7. Traumatic brain injury less than 3 weeks ago.

In all these conditions, thrombolysis therapy is not carried out. This is due to the fact that the risk of developing serious, life-threatening complications is greater than the positive effect of the procedure.

Therapeutic techniques

As mentioned earlier, there are systemic and selective methods for administering drugs. We will get to know which method is better taking into account the nature of the pathology that has arisen and how it is carried out.

System

They are considered universal. Systemic thrombolysis is done by injecting drip lysing agents through a vein. It is shown in the following cases:

Convenience lies in the fact that help can be provided both in the hospital and at the prehospital stage. Clinical recommendations for therapy – ECG and blood coagulation.

Selective

Another name is catheter thrombolysis. In this case, the catheter puts the doctor in a vein or artery affected by thrombosis.

How the procedure is carried out depends on the location of the thrombus:

  • Local thrombolysis with a heart attack is done in cardiac resuscitation by an intravenous catheter. The method serves as an alternative to coronary artery bypass grafting.
  • Selective thrombolysis in stroke is rare because it is difficult to access the cerebral arteries. Thrombolytic therapy for ischemic stroke using catheterization is possible only in clinics specializing in helping stroke patients.
  • Vein thrombosis. With this pathology, blood clot lysis is considered one of the simplest. The doctor injects the selected drug into the vein of the limb.

Which of the methods to use is decided individually.

Relative contraindications

There are situations in which thrombolysis therapy is undesirable, but it is possible in cases where the intended benefits of the procedure exceed the possible harm from it.

To date, the following relative contraindications to thrombolysis with myocardial infarction are distinguished:

  1. Transient ischemic attacks less than 6 months ago.
  2. Pregnancy.
  3. The postpartum period (less than 28 days after the resolution of pregnancy).
  4. Continuous use of direct anticoagulants.
  5. Long-term cardiopulmonary resuscitation, accompanied by trauma to the patient.
  6. The presence of gastric ulcers in the acute stage.
  7. Liver failure.
  8. Infectious endocarditis.
  9. Puncture of large vessels, inaccessible for compression.
  10. Any retinal hemorrhage.

Despite the large number of relative contraindications, most often doctors carry out thrombolysis in case of myocardial infarction, regardless of their presence, since without this procedure there is a high probability of developing the most serious consequences for patients.

Thrombolysis. Features of thrombolytic therapy for ischemic stroke

contraindications

55e9dcde4ab78b7f29ddda806f47b86a - Methods and drugs for thrombolysis in myocardial infarction

Thrombolytic therapy for myocardial infarction, stroke or pulmonary embolism is carried out with various medications. Thrombolytic drugs are selected taking into account the nature of the pathology, but sometimes, it is possible to use those drugs that are in the medicine cabinet (the ambulance list of drugs is limited). Consider the popular drugs for thrombolysis:

    Streptokinase A classic drug for dissolving blood clots, used for myocardial infarction or pulmonary embolism, less commonly – as a thrombolytic therapy for ischemic stroke. With thrombosis, the drug has a powerful lysing effect, but it greatly dilutes the blood and increases the permeability of the vascular wall. Streptokinase is considered a thrombolytic with a large number of side effects. Most often used for myocardial infarction and pulmonary embolism.

streptokinase - Methods and drugs for thrombolysis in myocardial infarction

Actilise. Mechanism of action: thrombolytics and fibrinolytics. The components of the drug, having reacted with fibrinogen, provoke lysis of a blood clot. Despite the fact that Actilize is a second-generation thrombolytic drug, the drug has few side effects and is often used in hospitals. Aktilize and other drugs of a new generation are considered the most popular means.

actilyse - Methods and drugs for thrombolysis in myocardial infarction

Urokinase. In the classification, 4 generations are considered a convenient medicine for the lysis of blood clots. When used, it gives few side effects, but is expensive.

urokinase - Methods and drugs for thrombolysis in myocardial infarction

Fortelizin. Like Actilize, it belongs to the second generation (this list of drugs is most popular for the treatment of thrombosis). Fortelizin is considered one of the best drugs for thrombolysis with a small amount of adverse reactions.

fortelisin - Methods and drugs for thrombolysis in myocardial infarction

The names of drugs from the group of thrombolytics of the 5th generation should not be listed. These modern drugs have a minimum of contraindications, are well tolerated, but are expensive and are used only in large clinics.

There are no oral agents for thrombolysis – drugs are used only in injection solutions. But some patients mistakenly confuse thrombolytics and anticoagulants (Warfarin), which are available in tablets and are indicated for long-term use.

Over the past decades, the main drug for thrombolysis was the drug Streptokinase. It belongs to the group of direct tissue plasminogen activators. This drug is relatively cheap, but not effective enough, and it often causes the development of serious side effects. Currently, indirect tissue plasminogen activators have become more widespread, the main of which are:

Thrombolysis with myocardial infarction, carried out by indirect tissue plasminogen activators more often passes without negative reactions and has good efficiency. Their main disadvantage is the relatively high cost in comparison with the drug Streptokinase.

These drugs provide binding of the enzyme to plasminogen located on fibrin. Under the influence of drugs, plasminogen turns into plasmin, while penetrating into fibrin. In the future, plasmin destroys fibrin, thereby ensuring the disintegration of the thrombus.

When thrombolysis is performed, microthrombi can form. The introduction of tissue plasminogen activators also contributes to an increase in platelet activity. All this requires concomitant antiplatelet therapy.

Today, thrombolysis with myocardial infarction at the prehospital stage is often practiced. For this, a drug such as Tenecteplase is best suited. It differs from other direct tissue plasminogen activators in its low probability of developing complications, as well as its ease of use. “Tenectoplase” is injected intravenously.

“Alteplase” is also sometimes used for thrombolysis with myocardial infarction at a prehospital level. Before its use, the patient is administered 5000 IU of heparin. Then 15 ml of Alteplase is administered bolus intravenously. After that, 0,75 ml of the drug per each kilogram of patient weight is administered dropwise to the patient for 30 minutes. In this case, the patient is constantly injected with heparin.

Streptokinase is recommended to be administered only in a hospital setting. When using this drug, thrombolysis with myocardial infarction is performed in the intensive care unit. The patient is administered intravenously drip 1500000 units of the drug diluted in 100 ml of physiological saline for 0,5-1 hours. In the case of this medication, heparin in the amount of 5000 units is also used before its administration. Subsequently, heparin is used no less than 4 hours after the end of the Streptokinase infusion.

On each form of the thrombolysis protocol for myocardial infarction, it is indicated that this procedure should be performed no later than 12 hours after the onset of the first symptoms of the disease. After thrombolysis therapy, it is necessary to be delivered to a specialized hospital within 12 hours for the purpose of stenting or balloon angioplasty. Compliance with this order significantly increases the patient’s chances of a positive outcome of the disease.

In the case of a paramedic or doctor of the ambulance team, these employees must perform the following actions before starting thrombolysis therapy:

  1. Clarify the patient’s time of occurrence and the nature of the pain syndrome.
  2. Perform electrocardiography to clarify the diagnosis of myocardial infarction and measure blood pressure.
  3. In the case of this diagnosis, the patient is given a tablet of nitroglycerin, “Aspirin” (if he has not taken it earlier).
  4. Subsequently, he is transferred to the ambulance when lying down.
  5. Already during transportation to the hospital, the effect of taking nitroglycerin (5 minutes) is evaluated.
  6. Also, the patient is given 5000 IU of heparin, at least 40 mg of statins (Atorvastatin, Rosuvastatin, Lovastatin) and drugs from the beta-blocker group (Metoprolol, Bisoprolol, Carvedilol) and ACE inhibitors ( “Enalapril”, “Lisinopril”, “Perindopril”, “Ramipril”) in a dosage that will not lower the level of blood pressure below 110/70 mm. Hg. Art. and heart rate less than 50 beats/min.
  7. In the future, the medical worker clarifies the presence of contraindications for thrombolysis. If they are absent, then this procedure begins.

In cases where a stationary health care facility is located near the place of emergency call, thrombolysis is most often performed in the intensive care unit in order to reduce the likelihood of serious complications and to stabilize the patient most quickly when they occur.

In the hospital, thrombolysis therapy is carried out under the constant supervision of a cardiologist/general practitioner and resuscitation doctor.

trombolizis pri infarkte6 - Methods and drugs for thrombolysis in myocardial infarction

After the procedure, doctors stabilize the patient’s condition and transfer to a specialized healthcare institution in order to perform angioplasty or stenting. After discharge from the hospital, the patient is sent to the outpatient stage of treatment, where he is recommended to take the following medications:

  • “Clapidogrel”;
  • “Aspirin”;
  • drugs from the group of beta-blockers;
  • drugs from the group of ACE inhibitors;
  • peripheral vasodilators (drugs that expand the coronary vessels).

These drugs significantly reduce the likelihood of recurring myocardial infarction. In the future, with a satisfactory condition of the patient, as well as the presence of sufficient recovery potential (the patient is not too old, able to move, accessible to productive contact) he is sent for rehabilitation, in order to restore normal life. In cases when it comes to young people, they are often sent to a rehabilitation course immediately after the inpatient phase of treatment.

How to evaluate the effectiveness

This procedure often proceeds quite hard for the patient. Adverse reactions develop in approximately 1% of patients undergoing thrombolysis with myocardial infarction. Among the most common side effects are:

  • severe headache;
  • increased body temperature;
  • the development of atrial fibrillation (at the same time, it is evaluated as an indicator of the restoration of blood flow in the myocardium);
  • development of bleeding at the injection site;
  • allergic reactions.

The complexity of the procedure, as well as the possible development of side effects, are some of the reasons why thrombolysis during myocardial infarction is most often performed in the intensive care unit (if the patient is in a hospital).

The degree of effectiveness of thrombolytic therapy is assessed using coronary angiography. Thanks to this study, a decrease in the size of the thrombus, the degree of patency of the coronary vessels for 30 minutes after the start of treatment, is determined. In some cases, re-thrombosis is detected.

The results of thrombolysis are evaluated using electrocardiography and a blood test, as well as using a special scale from zero to three:

  • at zero efficiency, there is no blood flow, and the contrast medium is below the site of the formation of a blood clot;
  • blood circulation is weak, due to which the arterial bed is not completely filled through small holes in the thrombus;
  • blood flow is slowed, partial filling of the channel is observed;
  • the lumen of the artery was completely filled with contrast medium, which indicates that the thrombus has completely resolved and the patency of the vessel has been restored.

Thanks to timely treatment, you can reduce the risk of developing cardiogenic shock and other consequences.

How much the procedure helps is assessed using MRI or Doppler ultrasound. Consider the main criteria for the effectiveness of thrombolysis:

  • Zero Means do not affect a blood clot.
  • First one. A slight lysis of the structure of the thrombus is noted.
  • The second one. Blood flow appears, but the bloodstream is partially relieved.
  • The third. The maximum therapeutic effect – the bloodstream is fully functioning.
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Whether thrombolysis is necessary or not is decided individually. But if the procedure is necessary, then you should not refuse – the resorption (lysis) of the thrombus will improve blood circulation and prevent complications of the disease.

Ambulance with thrombolysis in emergency conditions

In the emergency system for ambulance patients, the following clinical recommendations are indicated:

  • Tela. When this condition occurs, thrombolysis drugs are indicated, regardless of possible contraindications.
  • Stroke. If there is no certainty about the nature of stroke lesions, then the introduction of thrombolytics is undesirable. Recommendations to doctors and paramedics of the ambulance indicate that it is better to carry out maintenance therapy to eliminate the risk of intracranial bleeding in hemorrhagic stroke.
  • AMI Thrombolysis with myocardial infarction at the prehospital stage will help in the first hours. If more than 6 hours have passed since the attack, then only the introduction of narcotic analgesics and the delivery of the patient to the hospital are recommended.

All appointments are made by a doctor, and, in some cases, a medical assistant. Before applying thrombolysis at the prehospital stage, the possible benefits and harm to the patient are taken into account.

What are the complications?

In rare cases, thrombolysis is accompanied by the development of complications. In some patients, bleeding begins after administration of the drug. At the same time, hematocrit and hemoglobin are rapidly reduced. A blood test shows a decrease in platelet count. If this happens, then the treatment is stopped and other methods are used.

Every tenth patient has a sharp decrease in blood pressure. Recovery is noticed after discontinuation of therapy.

The prognosis after thrombolysis for heart attack in most cases is favorable. The procedure significantly increases the chances of recovery.

Thrombolytics are considered “difficult” means for the human body. Consider the common complications of thrombolytic therapy:

  • fever up to 38 ° and above;
  • acute heart failure;
  • cerebral hemorrhagic hemorrhages (with ischemic stroke);
  • heart rhythm disturbances;
  • drug hypotension;
  • internal and external bleeding.

To avoid unwanted reactions, thrombolysis is carried out under the control of electrocardiography and blood coagulation.

General information about thrombolysis

In the body of each person, a natural process of thrombolysis occurs. It is carried out using special enzymes in the blood. But these substances are not able to fully cope with large blood clots. They are effective only in the presence of small blood clots.

As a result, large clots formed block the lumen of the vessel in whole or in part. Because of this, circulatory failure occurs, which leads to starvation of the body’s cells and even their death. This phenomenon disrupts the functioning of internal organs.

Therefore, the question arises, how to dissolve a blood clot? To solve this problem, apply artifact thrombolysis. The essence of the technique is that the doctor injects medications into the veins, which are designed to dissolve blood clots.

Thrombolytic treatment is carried out in two ways:

  1. Systemic Its peculiarity is that it does not matter where the blood clot is located. The medicine spreads throughout the body along with blood and eventually collides with a blood clot, dissolving it. But this method of thrombolysis has one drawback – the need to use a large dosage of the drug, which negatively affects the circulatory system.
  2. Local. This method is characterized in that the medicine is administered directly to the area where the blood clot is located. The drug is delivered to the vessel using a catheter. This method is quite complicated, the implementation is controlled by an x-ray machine.

Which method to prefer when performing thrombolytic treatment is decided by the attending physician for each patient individually.

ostryy nespetsificheskiy kolit - Methods and drugs for thrombolysis in myocardial infarction

Where is thrombolytic therapy performed? Treatment can be carried out both at home and after hospitalization. Emergency thrombolytic treatment is the most effective, since it has an advantage with respect to time. After all, the sooner the procedure is completed, the more chances there are to save a person.

In this regard, hospital thrombolysis has a significant drawback. It is prescribed only after the patient is fully examined. Therefore, the speed of therapy is lower, but it is possible to check for contraindications to the use of thrombolytics, which avoids many adverse complications.

A stroke of the brain is a dangerous pathology that often leads to death. Even if a person survives, it is very difficult for him to recover. Indeed, with a disease, the blood supply to the brain cells is blocked, which leads to an acute violation of cerebral circulation (stroke) and the death of tissues.

Thrombolysis in stroke helps prevent adverse effects. It quickly dissolves the blood clot and prevents necrosis of brain cells. In this case, you need to have time to administer the drug within 6 hours from the onset of signs of pathology.

The same thing happens with a heart muscle infarction. The disease also occurs due to clogging of the lumen of an artery with a thrombus. Often this is accompanied by thrombophlebitis.

To prevent myocardial tissue from perishing, thrombolytic treatment should be performed.

It allows you to eliminate acute coronary syndrome (ACS), reduce the area of ​​muscle damage, maintain the function of the left ventricle, which pumps blood, as well as reduce the risk of complications and ensure stable heart function.

Indications for thrombolysis are various diseases of the heart and blood vessels, which are united by a phenomenon such as thrombosis. Similar diseases include:

  1. Stroke.
  2. Myocardial infarction.
  3. TEL – thromboembolism of the lung.
  4. Blockage by a clot of deep veins, peripheral arteries or artificial prostheses located in the vascular lumens.

The need for thrombolytic treatment is determined by the attending doctor after examining the patient.

Doctors distinguish several factors in the presence of which the carrying out of thrombolytic therapy is impossible. If you prescribe treatment without paying attention to contraindications, there is a high risk of complications.

It is forbidden to do thrombolysis with such pathologies:

  1. High blood pressure.
  2. Diabetes.
  3. Allergy to medicines used in the treatment process.
  4. Vascular damage.
  5. Malignant tumors.
  6. Poor blood coagulability.
  7. Renal or liver failure.
  8. Diseases of the digestive organs.
  9. Diseases that can cause bleeding, for example, an aneurysm.

In addition to pathological conditions, it is not allowed to carry out thrombolytic therapy for women who are bearing a child, as well as for people taking anticoagulants, who have recently undergone surgery or received a skull injury in the last 2 weeks. Thrombolysis is also contraindicated in patients whose age is more than 75 years.

In medicine, there are a huge number of thrombolytic drugs. They are constantly being improved. At the moment, there are the following types of medications that differ in the nature of the effect:

  1. Natural enzymes. They are used only for systemic TLT. They help restore fibrinolysis, have a resolving effect on blood clots. But drugs affect the whole body, which is fraught with the occurrence of bleeding, the development of allergies. Therefore, they are used to a limited extent.
  2. Genetic engineering tools. Restore fibrinogen in the blood. Affect only a blood clot. They differ in instant dissolution in the blood, so they are used with caution.
  3. Advanced group drugs. They are characterized by the fact that they act selectively and for a long period.
  4. Combined medicines. They include several medical devices at once.

From all groups, several thrombolytics can be distinguished, which are most often used for thrombolysis. These include:

  • “Streptokinase.” It has the lowest cost among all thrombolytic drugs. The disadvantage of its use is that a person often has intolerance to it, allergies and other unpleasant complications develop.
  • Urokinase. Despite the fact that the price of this drug is higher than the previous one, its advantages are small. When using the medication, additional use of Heparin is required.
  • “Tenecteplase.” On sale has another name – “Metalis”. It is injected, the use of “Heparin” and “Aspirin” is required. The drug can cause bleeding.
  • “Anistreplaza.” Also has a high cost. The introduction of this tool can be carried out in a jet. When using it is not necessary to enter “Heparin” into a vein.
  • Alteplaza. An expensive medication that has a highly effective effect. After its use, the survival of patients is much higher than with the use of other means. However, the drug has serious side effects.
  • “Actylase.” The medication acts directly on a blood clot, does not cause a strong dilution of blood, which prevents the occurrence of hemorrhage.

In addition to thrombolytics during thrombosis, other drugs are used, for example, diuretics (“Fitolizin”), anticoagulants (“Heparin”), antiplatelet agents (“Aspirin”). Also, to eliminate symptoms, improve blood circulation, additional folk remedies are allowed to be used. In extreme cases, resort to surgical intervention.

The doctor is engaged in the appointment of surgical or drug treatment, taking into account the patient’s condition, the degree of development of the pathology, the presence of concomitant diseases and other factors.

Thrombolysis can not only save the patient, but also cause adverse effects. These include:

  1. Bleeding. It occurs due to a deterioration in blood coagulability.
  2. Allergic reaction. It manifests itself in the form of skin rashes, accompanied by itching and swelling.
  3. Arrhythmia. Appears after restoration of coronary blood flow.
  4. Repeated manifestation of pain. With this complication, the administration of a narcotic analgesic into the vein is prescribed.
  5. Lowering blood pressure. To eliminate this side effect, it is enough to stop using thrombolytics.

The effectiveness of thrombolytic tablets and injections depends primarily on how timely the therapy was carried out. The greatest effect is achieved if the drug was administered no later than 5 hours after the onset of symptoms of pathology.

Unfortunately, it is far from always possible to carry out thrombolysis during this time. The problem lies in the fact that not all medical institutions have the opportunity to use the methodology in question.

How effective the therapy has been can be found through examination. To do this, conduct magnetic resonance or computed tomography in case of stroke or coronary angiography for heart muscle infarction. Diagnosis after thrombolysis shows the expansion of the lumen of the vessel and the destruction of the blood clot.

What should the patient do?

Myocardial infarction usually develops in cases where the patient already has another cardiovascular pathology. Most often, this disease is characterized by severe pain in the sternum, accompanied by radiation to the left shoulder, hand, shoulder blade, abdomen or neck, as well as severe weakness. If these symptoms occur, the patient is recommended to call an ambulance team, then measure blood pressure and, if its level is at least 120/80 mm. Hg. Art.

Forecast

If the dosages of the drugs are observed, thrombolysis with myocardial infarction in the vast majority of cases is successful. Even when using streptokinase, the number of serious complications does not exceed 2%. These performance indicators are relevant in cases where all recommendations of thrombolysis with myocardial infarction are followed.

Despite this procedure, the further quality of life of the patient will largely depend on the completeness and timeliness of other medical and rehabilitation measures. After thrombolysis, patients are advised to undergo a course of treatment in cardiology departments with possible angioplasty or stenting.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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