Thrombolytic drugs for heart attack
Small blood vessels called coronary arteries supply blood and oxygen to the heart.
- A heart attack can occur if a blood clot completely blocks one of these arteries.
- Unstable angina refers to chest pain and other warning signs that a heart attack may happen soon. It is most often caused by blood clots in the arteries.
Certain patients may be given drugs to break up the clot if the artery is completely blocked. These drugs are called thrombolytics, or clot busting drugs.
- These drugs should be given within 3 hours of when the patient first felt chest pain.
- The medicine is given through a vein (IV).
- Blood thinners taken by mouth may be prescribed later to prevent more clots from forming.
The main risk when receiving clot busting drugs is bleeding, especially bleeding in the brain.
Thrombolytic therapy is not safe for people who have:
- Bleeding inside the head or a stroke
- Brain abnormalities, such as tumors or poorly formed blood vessels
- Had a head injury within the past 3 months
- A history of using blood thinners or a bleeding disorder
- Had major surgery, a major injury, or internal bleeding within the past 3-4 weeks
- Peptic ulcer disease
- Severe high blood pressure
Other treatments that may be done instead of thrombolytic therapy are:
- Angioplasty is a procedure to open narrowed or blocked arteries that supply blood to the heart. It is often the first choice treatment.
- Heart bypass surgery to open narrowed or blocked arteries that supply blood to the heart may also be done. This procedure is also called "open heart surgery."
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50(7):e1-e157.
Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, writing on behalf of the 2004 Writing Committee. Circulation. 2008;117(20:296-329.
Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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