Thrombolytic injections are in the news again as the Andhra Pradesh government is offering them for free to the people residing in the state. The initiative in partnership with the Indian Council of Medical Research (ICMR) aims to help save the lives of people from heart attacks within the golden hour period.
What is thrombolytic therapy?
ST Elevation Myocardial Infarction (STEMI) is a full-blown heart attack where the heart muscle wall is damaged mostly due to blood clots. Experts say that 50 percent of these cases occur in people with no history of heart conditions. In these cases, thrombolytic injections can help dissolve the arterial clots, which have caused the heart attack.
Dr Shuvanan Ray, Director, cardiology, Fortis Anandapur, Kolkata, says that if the injection is administered within the golden hour or at least within four hours of the onset of chest pain, it can offer the same benefits as a primary angioplasty.
Dr Pradeep Kumar D, senior consultant, cardiology, Manipal Hospital, Yeshwanthpur, Bengaluru, adds in cases of STEMI where the ECG shows a pattern of ST elevation, one should be treated as quickly as possible. Though the preferred treatment is angioplasty, where a balloon or stent is used, it may not be possible to do so immediately due to the non-availability of medical professionals and catheterization labs, especially in remote areas.
He explains, “STEMI is a full-blown heart attack where the entire muscle wall is damaged. In such instances, there can be a 90 to 100 percent block in the blood-supplying artery. So, the area of the heart that doesn’t get blood supply starts getting damaged, or, in medical terms, infarcted.”
Thrombolytic injection
Dr Ray adds, “When you develop chest pain and reach out to emergency services, they administer the thrombolytic drug as an intravenous injection. It is a simple single shot injection that can reduce mortality by 15-20 percent.” He adds that it has the potential to abort angioplasty or buy the time for one to go to the nearest medical center for further treatment. “Sometimes, there may be only one clot blocking an artery. After thrombolysis, the clot is gone, and arteries open. So, you may require no further treatment,” he says.
However, according to international guidelines, an angiogram needs to be performed between three and 24 hours after injecting the medicine. These thrombolytic injections have over 60 percent success rate, say experts. However, there are chances of failed thrombolysis, where the arteries do not open up with medication. In such cases, one may have continuous chest pain and their ECG does not settle. “Hemodynamic instability or cardiogenic shock and pulmonary edema are all the indications to perform an angiogram,” says Dr Kumar. He adds that an ECG is usually carried out an hour after the medicine is administered as the clot usually gets dissolved within 30 – 60 minutes of its administration.
Thrombolytic injection side-effects
Thrombolytic injections can also have severe side effects. One may develop bleeding in the brain and other areas. Further, cardiac rupture and allergic reactions may occur. Hence, the medicine is not recommended for older people and those with a history of high blood pressure, stroke or recent surgery as they have higher chances of bleeding. However, experts share that the risks are lower with the newer thrombolytic medicines.
Regarding the Andhra model, Dr Ray also shares that the same initiative was earlier carried out by the government in Chennai. “This is called a hub-and-spoke model (a distribution network). There is a hub where you send your ECG and once you’re diagnosed, they order thrombolysis (clot-busting). Following this, one can go to the nearest medical center for an angiogram or angioplasty. We also call it a pharmacoinvasive therapy,” he explains.
Takeaway
- The thrombolytic injection can help save the lives of people from heart attacks in the golden hour period. It works by dissolving the clot inside the arteries, which can otherwise block the blood supply and cause a heart attack.
- It comes in handy in emergencies, especially when there is a possibility of the non-availability of medical professionals and cath labs.
- If administered within the golden period, it can offer the same benefits as that of an angioplasty.
- The injection can also cause severe complications like internal bleeding. Hence, it is not administered to people with a history of high blood pressure or stroke as well as anyone who has had surgery recently.
