Thrombolysis
Date issued: November 2024
For review: November 2026
Ref: B-531/LD/Radiology/Thrombolysis
PDF: Thrombolysis.pdf [pdf] 199KB
This leaflet tells you about having thrombolysis. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to an Interventional Radiologist for this procedure. Interventional Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form if one hasn’t been previously completed. This form says that you need to know what risks are involved. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is thrombolysis?
Thrombolysis is the breakdown of blood clots with the use of drugs. Once a clot starts to form in a blood vessel, it may continue and block the whole vessel.
While an operation may be necessary to remove the clot, it is also possible to dissolve the clot by directly injecting a special ‘clot-busting’ drug into the artery or vein. This can lead to a great improvement in blood flow and may avoid the need for an operation.
Sometimes an underlying narrowing is revealed in the blood vessel once the clot has dissolved and it may be possible to treat this by angioplasty (balloon) or stent insertion at the same time. To make the procedure work quicker a thrombectomy can sometimes be performed where the clot is sucked out of the body.
Why do you need thrombolysis?
Your doctors know that there is a blockage in a blood vessel based on the tests you have already had. These tests might include a Doppler ultrasound scan, magnetic resonance imaging (MRI) or computed tomography (CT) angiography. If nothing is done about the situation, then severe and permanent damage may occur. While the blockage could need treatment with surgery, in your case, it has been decided that thrombolysis is the best way of proceeding.
Are there any risks?
Thrombolysis is generally a safe procedure, but as with any medical procedure there are some risks and complications that can arise. Bruising at the puncture site is very common and rarely may require a small operation. Occasionally, ongoing leakage from the puncture site may cause a swelling called a ‘false aneurysm’ that may require a further procedure.
Clot-busting drugs have to be very powerful to work, consequently there is a risk that bleeding will occur elsewhere in your body. Commonly, this is from the bowel and might require treatment or stopping the thrombolysis. Very rarely, bleeding can occur in the brain and cause a stroke.
Blockage of the arteries to the legs can occur, resulting in an operation and very rarely leg amputation may occur.
Sometimes the blood clot may be so extensive that the clot-busting drug simply cannot dissolve it all away. In these cases, surgery may be required to relieve the blockage.
Some complications can be life threatening and although rare, death should also be considered as a risk of this procedure.
Kidney damage can occur due to a high volume of contrast agent (x-ray dye) used in this procedure.
IM injections must not be used during thrombolysis treatment due to risk of bleeding.
If angioplasty or venoplasty is required, then there are additional risks related to these procedures (see the relevant patient information leaflets)
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
This procedure requires a stay in hospital until the treatment is complete. You will be admitted to an appropriate ward prior to the procedure where you will be asked to get undressed and put on a hospital gown.
A small cannula (thin tube) will be placed into a vein in your arm.
It is performed under local anaesthetic and mild sedation if needed.
If you have a morning appointment, you will be asked to have nothing to eat from midnight although you may still drink water up to 6am then sips of water for the 2 hours before your examination.
If you have an afternoon appointment you may eat normally up to 6am and then water only up to 10am with sips of water for the 2 hours before your examination.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
Our porters will collect you and bring you to the interventional radiology suite which is located within
X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during thrombolysis?
Before the procedure, the Interventional Radiologist will explain the procedure and ask if you have signed a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
You will lie on the X-ray table, generally flat on your back (sometimes on your tummy). The radiologist or nurse can give you sedation or painkillers if appropriate, but it is normal to remain awake during the procedure. Your pulse, blood pressure, ECG, and blood oxygen levels will be monitored throughout the procedure, and you may be given oxygen.
The procedure is performed under sterile conditions and the Interventional Radiologist and radiology nurse will wear sterile gowns and gloves to carry out the procedure. The skin near the point of insertion, usually the groin, will be swabbed with antiseptic and you will be covered with sterile drapes. The skin and deeper tissues over the artery or vein will be numbed with local anaesthetic, and a fine plastic tube (catheter) is then passed over a wire and into the artery or vein.
The Radiologist will use the X-ray equipment and small amounts of dye (contrast agent) to make sure that the catheter is moved into the right position, very close or actually into the blood clot.
The clot-busting drug (thrombolytic) is injected down the catheter and into the blood clot. The catheter is left in the artery or vein and attached to an infusion pump, so that injection of the clot-busting drug can be continued over hours (occasionally up to 48–72 hours) during which time you will be transferred back to the ward for careful observation. The Radiologist will check progress periodically by injecting the dye to show how much of the clot has dissolved.
Once the procedure is completed, the catheter will be removed, and firm pressure applied, for about ten minutes, to prevent any bleeding.
Will it hurt?
When the local anaesthetic is injected, it will sting for a short while, but this soon wears off. You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine.
Some patients have pain once the drug-busting clot is started. You will be given strong pain killers.
How long will it take?
Every patient is different, and it is not always easy to predict; however, expect to be in the radiology department for at least an hour initially. You may require several trips to the X-ray department to check on progress and sometimes an underlying narrowing is revealed once the clot has cleared which may be treated at the time by angioplasty or stent.
What happens afterwards?
You will be taken back to your ward. This is routinely an HDU or ICU ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You will be required to stay in hospital until the treatment is complete.
Other Risks
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 430838 - IR Co-ordinator
01752 432063 – Bookings Clerk
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Monday to Saturday (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
Comments and Suggestions
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