thrombolytic

A blood clot is a mass of blood that forms when platelets, proteins, and cells in the blood stick together. When you get hurt, your body forms a blood clot to stop the bleeding. After the bleeding stops and healing takes place, your body usually breaks down and removes the blood clot. But sometimes the blood clots form where they shouldn't, your body makes too many blood clots or abnormal blood clots, or the blood clots don't break down like they should. These blood clots can be dangerous and may cause other health problems.

Blood clots can form in, or travel to, the blood vessels in the limbs, lungs, brain, heart, and kidneys. The types of problems blood clots can cause will depend on where they are:

• Deep vein thrombosis (DVT) is a blood clot in a deep vein, usually in the lower leg, thigh, or pelvis. It can block a vein and cause damage to your leg.
• A pulmonary embolism (PE) can happen when a DVT breaks off and travels through the bloodstream to the lungs. A PE, especially if it is large, can damage your lungs and prevent your other organs from getting enough oxygen.
• Cerebral venous sinus thrombosis (CVST) is a rare blood clot in the venous sinuses in your brain. Normally the venous sinuses drain blood from your brain. CVST blocks the blood from draining and can cause a hemorrhagic stroke.
• Blood clots in other parts of the body can cause problems such as an ischemic stroke, a heart attack, kidney problems, kidney failure, and pregnancy-related problems.

Certain factors can raise your risk of developing blood clots:

• Atherosclerosis
• Atrial fibrillation
• Being overweight or having obesity
• Cancer and cancer treatments
• Certain genetic disorders
• Certain surgeries
• COVID-19
• Diabetes
• Family history of blood clots
• Overweight and obesity
• Pregnancy and giving birth
• Serious injuries
• Some medicines, including birth control pills
• Smoking
• Staying in one position for a long time, such as being in the hospital or taking a long car or plane ride

The symptoms for blood clots can be different, depending on where the blood clot is:

• In the abdomen: Abdominal pain, nausea and vomiting
• In an arm or leg: Sudden or gradual pain, swelling, tenderness, and warmth
• In the lungs: Shortness of breath, pain with deep breathing, rapid breathing, and increased heart rate
• In the brain: Trouble speaking, vision problems, seizures, weakness on one side of the body, and sudden severe headache
• In the heart: Chest pain, sweating, shortness of breath, and pain in the left arm

To find out if you have one or more blood clots, your health care provider:

• Will do a physical exam.
• Will take your medical history, which includes asking about your symptoms.
• May order blood tests, including a D-dimer test.
• May order imaging tests, such as
  • Ultrasound.
  • X-rays of the veins (venography) or blood vessels (angiography) that are taken after you get an injection of special dye. The dye shows up on the x-ray and allows the provider to see how the blood flows.
  • CT Scan.

Treatments for blood clots depend on where the blood clot is located and how severe it is. Treatments may include:

• Blood thinners.
• Other medicines, including thrombolytics. Thrombolytics are medicines that dissolve blood clots. They are usually used where the blood clots are severe.
• Surgery and other procedures to remove the blood clots

You may be able to help prevent blood clots by:

• Moving around as soon as possible after having been confined to your bed, such as after surgery, illness, or injury
• Getting up and moving around every few hours when you have to sit for long periods of time, for example if you are on a long flight or car trip
• Wearing compression stockings after surgery or during a long flight
• Regular physical activity
• Not smoking
• Staying at a healthy weight

Some people at high risk may need to take blood thinners to prevent blood clots.

Each year almost 800,000 Americans have a heart attack. A heart attack happens when blood flow to the heart suddenly becomes blocked. Without the blood coming in, the heart can't get oxygen. If not treated quickly, the heart muscle begins to die. But if you do get quick treatment, you may be able to prevent or limit damage to the heart muscle. That's why it's important to know the symptoms of a heart attack and call 911 if you or someone else is having them. You should call, even if you are not sure that it is a heart attack.

The most common symptoms in men and women are:

• Chest discomfort. It is often in center or left side of the chest. It usually lasts more than a few minutes. It may go away and come back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion.
• Shortness of breath. Sometimes this is your only symptom. You may get it before or during the chest discomfort. It can happen when you are resting or doing a little bit of physical activity.
• Discomfort in the upper body. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach.

You may also have other symptoms, such as nausea, vomiting, dizziness, and lightheadedness. You may break out in a cold sweat. Sometimes women will have different symptoms then men. For example, they are more likely to feel tired for no reason.

The most common cause of heart attacks is coronary artery disease (CAD). With CAD, there is a buildup of cholesterol and other material, called plaque, on their inner walls or the arteries. This is atherosclerosis. It can build up for years. Eventually an area of plaque can rupture (break open). A blood clot can form around the plaque and block the artery.

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery.

At the hospital, health care providers make a diagnosis based on your symptoms, blood tests, and different heart health tests. Treatments may include medicines and medical procedures such as coronary angioplasty. After a heart attack, cardiac rehabilitation and lifestyle changes can help you recover.

NIH: National Heart, Lung, and Blood Institute

A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

There are two main types of strokes, ischemic and hemorrhagic. Ischemic stroke is the more common type. An ischemic stroke happens when a blood clot blocks a blood vessel in the brain. Quick treatment can save a life and improve the chances of recovery.

Ischemic strokes are usually caused by one or more of the following:

• A blood clot. A clot can form in an artery that supplies the brain (thrombosis), or it can travel from another part of the body (embolism).
• Atherosclerosis. A disease in which plaque, a sticky substance made up of cholesterol, fat, and other substances, builds up inside your arteries.
• Irregular heart rhythms. Conditions like atrial fibrillation can cause clots to form in the heart, which may travel to the brain.
• Other heart and blood conditions. Such as heart valve diseases or sickle cell disease.

A transient ischemic attack (TIA) is caused by a brief blockage of blood flow to the brain. It usually lasts a few minutes. Having a TIA can mean you are at risk for having a more serious stroke.

Symptoms of stroke often happen suddenly. They include:

• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

If you think someone is having a stroke, the F.A.S.T. test can help you remember what to look for. Think "FAST" and look for:

• Face drooping on one side when smiling.
• Arm weakness that occurs when the arms are raised, and one arm drifts downward.
• Speech is slurred or strange.
• Time to call 911.

To make a diagnosis, your health care provider may do a physical exam, ask about your symptoms and medical history, and use imaging tests. Other heart tests may be done to help find the cause of the stroke.

It is important to treat strokes as quickly as possible. The most common treatments include:

• Medicines such as blood thinners or thrombolytics (which break up and dissolve existing clots) may be used to prevent or treat ischemic stroke.
• Surgery or stenting may be used to open narrowed arteries or remove plaque build-up from the carotid arteries, which supply blood to the brain.

After treatment, rehabilitation can help you regain lost skills and independence. Your provider may also order other medicines to manage your blood pressure,cholesterol, or other health problems such as diabetes that may increase your risk for stroke.

The best way to prevent stroke is by making heart-healthy lifestyle changes to lower your risk. If lifestyle changes aren't enough, your provider may prescribe medicine to help manage your risk factors.

NIH: National Institute of Neurological Disorders and Stroke

A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause:

• Permanent damage to the lungs
• Low oxygen levels in your blood
• Damage to other organs in your body from not getting enough oxygen

PE can be life-threatening, especially if a clot is large, or if there are many clots.

The cause is usually a blood clot that breaks loose and travels through the bloodstream to the lungs. The clot is usually a deep vein thrombosis (DVT), a clot in the leg. In rare cases, material such as air bubbles, clumps of fat, or parts of a tumor can block the lung artery and cause PE.

Anyone can get a pulmonary embolism (PE), but certain things can raise your risk of PE:

• Having surgery, especially joint replacement surgery.
• Certain medical conditions, including
• Cancers
• Heart diseases
• Lung diseases
• A broken hip or leg bone or other trauma
• Hormone-based medicines, such as birth control pills or hormone replacement therapy.
• Pregnancy and childbirth. The risk is highest for about six weeks after childbirth.
• Not moving for long periods, such as being on bed rest, having a cast, or taking a long plane flight.
• Age. Your risk increases as you get older, especially after age 40.
• Family history and genetics. Certain genetic changes that can increase your risk of blood clots and PE.
• Obesity.

Symptoms of PE include:

• Shortness of breath
• Rapid breathing
• Chest pain or discomfort, which usually gets worse when you cough or take a deep breath
• Increased heart rate
• Coughing up blood
• Very low blood pressure, lightheadedness, or fainting

Sometimes people with PE don't have any symptoms until they have serious complications, such as pulmonary hypertension (high blood pressure in the arteries to your lungs).

It can be difficult to diagnose PE. To find out if you have a PE, your health care provider will:

• Take your medical history, including asking about your symptoms and risk factors for PE
• Do a physical exam
• Likely order some tests, including various imaging and blood tests

If you have PE, you need medical treatment right away. The goal of treatment is to break up clots and help keep other clots from forming. Treatment options include medicines and procedures.

Medicines:

• Anticoagulants, or blood thinners, keep blood clots from getting larger and stop new clots from forming. You might get them as an injection, a pill, or through an I.V. (intravenous). They can cause bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.
• Thrombolytics are medicines to dissolve blood clots. You may get them if you have large clots that cause severe symptoms or other serious complications. Thrombolytics can cause sudden bleeding, so they are used if your PE is serious and may be life-threatening.

Procedures:

• Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure.
• A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming.

Preventing new blood clots can prevent PE. Prevention may include:

• Continuing to take blood thinners. It's also important to get regular checkups with your provider, to make sure that the dosage of your medicines is working to prevent blood clots but not causing bleeding.
• Heart-healthy lifestyle changes, such as heart-healthy eating, exercise, and, if you smoke, quitting smoking.
Using compression stockings to prevent deep vein thrombosis (DVT).
• Moving your legs when sitting for long periods of time (such as on long trips).
• Moving around as soon as possible after surgery or being confined to a bed.

NIH: National Heart, Lung, and Blood Institute