trombolisis

Thrombolysis, also called trombolisis in some languages, is the medical dissolution of blood clots by pharmacologic agents that activate the body's fibrinolytic system, converting plasminogen to plasmin and degrading fibrin.

It is used in acute settings where rapid clot dissolution can restore blood flow, including ST-elevation myocardial infarction (STEMI), acute ischemic stroke within a defined time window, and certain cases of massive or high-risk pulmonary embolism. There are systemic (intravenous) and catheter-directed approaches.

The most widely used drugs are recombinant tissue plasminogen activators such as alteplase (rtPA) and, less commonly, tenecteplase or reteplase. Older options include streptokinase and urokinase. rtPA converts plasminogen to plasmin, which degrades fibrin clots.

Contraindications include active major bleeding, recent intracranial surgery or hemorrhage, intracranial neoplasm, suspected aortic dissection, severe uncontrolled hypertension, and known bleeding disorders. Timing is critical; stroke treatment is within a few hours of onset, while indications for myocardial infarction and pulmonary embolism depend on severity and clinical context.

Risks include bleeding, especially intracranial hemorrhage, allergic reactions to streptokinase, and reperfusion arrhythmias. Thrombolysis has largely been complemented by mechanical thrombectomy for many large vessel strokes, and catheter-directed approaches are used to limit systemic bleeding.