Pulmonary Artery Thrombolysis

A pulmonary embolism is a blockage (often a blood clot) that is found in a person’s lungs. Many times, the clot first forms in a leg, breaks off, and travels up into lungs, where it becomes lodged in pulmonary tissue. The clot obstructs blood flow to the lung, disrupting the exchange of oxygen and lung functioning. A pulmonary embolism can be fatal if it is not treated.  

Patients complaining of sudden, severe chest pain, a shortness of breath, anxiety, and a dry cough should be evaluated for a clot in the lungs. If a pulmonary artery thrombosis confirmed, injectable blood thinners may be prescribed to dissolve the clot over time. A thrombolysis is another treatment approach. This minimally invasive procedure involves the direct delivery of anti-clot therapies to the clot. This is often recommended for patients who have a significant blockage.

Why Pulmonary Artery Thrombolysis is Performed

When blood solidifies into a clot, it can cause damage to tissues and organs. Clots are classified according to how they impact the function of the heart. A “massive” blockage puts a patient at a high risk for death. Aggressive therapy in the form of thrombolysis is needed for these cases. The procedure uses a medication called tissue plasminogen activator (tPA).  tPA is very effective at breaking up clots thanks to its rapid blood thinning capabilities. tPA is delivered directly to the lungs through a catheter (a thin plastic tube).

What to Expect During Pulmonary Artery Thrombolysis

Given the urgency of a massive pulmonary embolism, a thrombolysis often happens directly following patient evaluation in an hospital emergency department. An interventional radiologist performs the procedure. First, the patient is made comfortable with conscious sedation medication, delivered through an intravenous (IV) line. Next, the femoral artery area of the groin is numbed with local anesthesia. The interventional radiologist makes a small incision and advances the catheter into the pulmonary artery until it reaches the clot. X-ray imaging guidance helps the physician perform this part of the procedure safely. Once the catheter arrives at the clot, the tPA is infused into the clot. The catheter may be left in place over a 24-hour period. During this time, the patient is admitted to the hospital. It is vital that the patient lay still until the infusion is complete. Medication will be given to keep the patient comfortable while the tPA works on dissolving the clot.

Risks and Benefits of Pulmonary Artery Thrombolysis

The goal of pulmonary artery thrombolysis is to dissolve the clot and reduce the chance of sudden death. While pulmonary artery thrombolysis has shown great success in treating massive clots and lowering a patient’s risk of death, there is a significant risk of internal bleeding. The care team will assess the patient’s overall health risk, age, and cardiac function in order to determine a safe and appropriate dosing and delivery rate of tPA to mitigate the risk of bleeding.

How to Prepare for Pulmonary Artery Thrombolysis

Since thrombolysis is used primarily to resolve dangerous, massive clots, it is unlikely to be a scheduled event. There is too much risk that a patient could die while waiting for a pulmonary artery thrombolysis, so it is typically an emergency procedure. Given the inherent risk of pulmonary artery thrombolysis, a patient needs to sign an informed consent form stating that they understand the risks and permit the physician to proceed. Assuming the patient is in the hospital already, the pre-procedure review (questions about current medications, smoking, any known allergies) will likely happen in an accelerated fashion as the team is actively preparing the procedure room.

Post Pulmonary Artery Thrombolysis

Patients typically remain hospitalized for a few days following pulmonary artery thrombolysis. During this time, they are monitored for any bleeding. Imaging studies are ordered to visualize any remaining pieces of the clot, as well as any organ or tissue damage and impact on blood flow resulting from the clot.

After the cause of the clot is determined, the provider will discuss lifestyle changes or other treatment with the patient. This often includes long term-use of a blood thinner to prevent new clots or a redevelopment of a clot in the same vessel.

Each patient will have a different recovery timeline. Movement and exercise are beneficial to preventing future clots but activity should be resumed slowly, as patients may feel fatigue for some time following pulmonary artery thrombolysis. The care team will devise post-discharge recovery and follow-up plans based on each patient’s set of circumstances.

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