trombolisi

Trombolisi (thrombolysis) is a medical treatment that dissolves blood clots obstructing blood vessels. It uses drugs called thrombolytic or fibrinolytic agents to convert plasminogen into plasmin, an enzyme that breaks down fibrin, the structural component of clots. The goal is to restore blood flow quickly to limit tissue damage.

Common indications include acute ischemic stroke, acute myocardial infarction when percutaneous coronary intervention is not available, massive pulmonary embolism with hemodynamic compromise, and clearance of occluded intravascular catheters. Agents used include tissue plasminogen activator (alteplase, tenecteplase), streptokinase, and urokinase. Administration can be systemic (intravenous) or catheter-directed (intra-arterial or local infusion), depending on the clinical situation.

Effectiveness is highly time-dependent: earlier treatment is associated with better outcomes. For example, intravenous thrombolysis for ischemic stroke has a limited therapeutic window that varies by protocol and patient factors. Risks include bleeding complications, most seriously intracranial hemorrhage, as well as allergic reactions and reperfusion injury. Major contraindications include active internal bleeding, recent intracranial hemorrhage or surgery, uncontrolled hypertension, and known bleeding disorders.

Clinical decisions about trombolysis require rapid specialist assessment, imaging to rule out hemorrhage, and weighing benefits against risks. Alternatives or complements include anticoagulation, mechanical thrombectomy, and percutaneous interventions, chosen according to the type and location of the clot and patient-specific factors.