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Venous thrombolytic therapy is a procedure used to treat a blood clot in a vein in the arm or leg. If the blood clot blocks blood flow through the vein, symptoms such as pain and swelling can result. During thrombolytic therapy, clot-busting medication is used to help dissolve the blood clot to restore blood flow through the vein. This sheet explains how the treatment is done.
Thrombolytic therapy holds increased risks for patients with certain health problems. For this reason, a detailed health history must be taken to check whether it is safe to have the treatment. Be sure to tell the doctor about any health problems you have. The doctor will also ask whether you’ve had specific problems, such as a prior stroke, head injury, or bleeding in the brain.
Tests will likely be done before the treatment. This includes blood tests and imaging tests.
Tell your doctor if you:
Take any medications. Be sure to mention if you take medications that slow down or prevent blood clotting. Also, mention if you take any over-the-counter drugs, herbs, and supplements. You may need to stop taking some or all of them before the treatment.
Are allergic to any medications. Also mention if you are allergic to contrast material (dye) or if you have ever had a reaction to substances used during other tests or procedures.
Have other health problems, such as diabetes or kidney problems.
Are pregnant or may be pregnant.
Have ever had any type of cancer.
Follow any directions you’re given for not eating or drinking before the treatment.
The treatment is done in a hospital. It is most often done by a doctor called an interventional radiologist.
Before the treatment begins:
An IV line is put into a vein in your arm or hand. This line supplies fluids and medications.
You’ll be given medication to keep you free of pain during the treatment. You’ll likely receive sedation, which makes you relaxed and sleepy.
During the treatment:
Medication is injected into the skin to numb the site to be worked on. This is usually in the leg.
A small needle is used to make a puncture through the numbed skin to gain entry into a blood vessel.
A thin tube called a catheter is put through the puncture. It is gently guided through a blood vessel that leads to the vein with the clot. Live x-rays are used to guide the procedure. The x-rays are viewed on a video screen.
Contrast material is injected through the catheter to make the blood vessels visible on the x-rays.
Once the catheter reaches the clot, the medication is slowly injected. In some cases, a mechanical or suction device may be attached to the end of the catheter to help break up the clot as well.
The catheter is left in place until the clot dissolves. This usually takes about 12-24 hours, but can take up to 72 hours or longer.
X-rays may be taken at various times during this period to check the progress of the treatment.
The catheter is removed once the treatment is done. Pressure is applied to the insertion site to stop any bleeding. The site is then bandaged.
After the treatment: For small clots, you may be able to go home the same day. For larger or more complex clots, you may need to stay in the hospital for one or more days. You’ll be monitored closely by nurses and doctors during your time in the hospital. When the doctor gives you the okay to go home, have an adult family member or friend ready to drive you.
Once at home, follow all instructions you’ve been given. Be sure to:
Drink plenty of water to help flush any remaining contrast material out of your body.
Take all medications as directed.
Care for the catheter insertion site as directed.
Check for signs of infection at the insertion site (see below).
Avoid heavy lifting or strenuous activities as directed.
Walk at least a few times daily. Slowly increase your pace and distance as you feel able.
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Chest pain or trouble breathing
Signs of infection at the catheter insertion site, such as increased redness or swelling, warmth, worsening pain, bleeding, or foul-smelling discharge
Numbness or tingling in the affected arm or leg
Pain in the affected arm or leg that won’t go away or gets worse
Affected arm or leg becomes swollen, blue, or cold
You’ll have a follow-up visit with your doctor in 7-10 days. Depending on the cause of the blood clot, other treatments may be needed in the future. Your doctor will tell you more about this.
Bleeding or infection due to problems at the catheter insertion site
Bleeding at any site that the clot-busting medication may have reached (Note: If bleeding occurs in the brain, this could lead to a stroke.)
Parts of the clot may break off and migrate to places that are difficult to reach, which may require further treatments
Allergic reaction to the clot-busting medication
Problems due to the contrast material, including allergic reaction or kidney damage
Risks of anesthesia or any other medications used during the treatment (these risks will be discussed with you prior to the treatment)