Thrombolytic drugs for heart attack
Myocardial infarction - thrombolytic; MI - thrombolytic; ST - elevation myocardial infarction; CAD - thrombolytic; Coronary artery disease - thrombolytic; STEMI - thrombolytic
Small blood vessels called coronary arteries supply oxygen carrying blood to the heart muscle.
- A heart attack can occur if a blood clot stops the flow of blood through one of these arteries.
- Unstable angina refers to chest pain and other warning signs that a heart attack may happen soon. It is most often caused by blood clots in the arteries.
Video: Heart attack (myocardial infarction) overview
Some people may be given drugs to break up the clot if the artery is completely blocked.
- These drugs are called thrombolytics, or clot-busting drugs.
- They are only given for a type of heart attack, where certain changes are noted on the ECG. This type of heart attack is called an ST segment elevation myocardial infarction (STEMI).
- These drugs should be given as soon as possible after the chest pain first occurs (most often in less than 12 hours).
- The medicine is given through a vein (IV).
- Blood thinners taken by mouth may be prescribed later to prevent more clots from forming.
The main risk when receiving clot-busting drugs is bleeding, with the most serious being bleeding in the brain.
Thrombolytic therapy is not safe for people who have:
- Bleeding inside the head or a stroke
- Brain abnormalities, such as tumors or poorly-formed blood vessels
- Had a head injury within the past 3 months
- A history of using blood thinners or a bleeding disorder
- Had major surgery, a major injury, or internal bleeding within the past 3 to 4 weeks
- Peptic ulcer disease
- Severe high blood pressure
Other treatments to open blocked or narrowed vessels that may be done in place of or after treatment with thrombolytic therapy include:
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;64(24):e139-e228. PMID: 25260718 www.ncbi.nlm.nih.gov/pubmed/25260718.
Bohula EA, Morrow DA. ST-elevation myocardial infarction: management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 59.
Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. PMID: 28886621 www.ncbi.nlm.nih.gov/pubmed/28886621.