Basic principles of thrombolysis procedure
What are the basic principles in performing a thrombolysis procedure?
Catheter-directed pharmacologic thrombolysis therapy consists of the delivery of a lytic agent directly into a thrombosed vessel or graft. The catheter is largely responsible for instilling the lytic agent only within the thrombosed segment so that relatively small overall doses of a lytic agent can achieve high local concentration within the clot. In this way, significant local effects can be achieved while minimizing systemic effects, thereby decreasing the risk of bleeding at other sites. The immediate goal of the procedure is to lyse an unwanted clot while preventing a systemically lytic state to minimize bleeding complications. The secondary goal of a thrombolysis procedure is to uncover the cause of the thrombosis. Commonly, bypass grafts and native vessels thrombose because of stenoses in inflow vessels, anastomoses, or outflow vessels. Unless the underlying cause for the thrombosis is treated, thrombosis is likely to recur. Less commonly, there are instances in which grafts or vessels thrombose without underlying stenoses. Embolic disease, diminished cardiac output, and noncompliance with anticoagulation therapy are some causes of thrombosis in the absence of an underlying stenosis.