Thrombolytics

A thrombolytic is used when an existing clot is blocking blood flow and the threatened tissue may still be rescued. These drugs activate plasminogen, producing plasmin; plasmin digests fibrin, the protein mesh that holds a mature thrombus together. As the clot breaks down, perfusion can return. The same action that can restore perfusion can also cause catastrophic bleeding. That balance drives every nursing decision. The question is not simply whether alteplase or tenecteplase dissolves clot. It is whether this patient has a time-sensitive indication, whether haemorrhage has been excluded, and whether the expected benefit justifies the bleeding risk. Thrombolysis is different from anticoagulation and antiplatelet therapy. Anticoagulants limit thrombin generation and clot extension; antiplatelet agents reduce platelet aggregation. A thrombolytic actively lyses fibrin in a clot that is already present. It therefore does not replace the separate plan for preventing further thrombosis.