Thrombolysis
Blood thinners alone, do not remove the clot but allow time to the body to dissolve the clot. Unfortunately, in cases of life threatening (massive) pulmonary embolism there is no time to wait and more aggressive measures are needed.
Thrombolytics ("clot busters") can dissolve a clot quickly, over a period of a few hours. These clot busters can be administered either through a peripheral arm vein (systemic thrombolysis) at the intensive care unit bedside or through a long catheter (thin tube) that delivers them directly into the lung clot (catheter directed thrombolysis).
A major risk of this treatment is the risk of bleeding as any other clot within the body will be also busted. For this reason it cannot be applied to all patients e.g. those with active bleeding, recent surgery or trauma.
Systemic thrombolysis is currently the standard of care for massive pulmonary embolism, however as the thombolytic drug is not delivered directly into the clot, high dose is needed and the rate of bleeding complications including brain bleed (stroke) is relatively high, still though can be justified given the life threatening nature of the disease.
The use of catheter-directed thrombolysis is emerging as an effective alternative in patients with high risk pulmonary embolism.
As the drug is administered directly into the clot, lower dose is needed and the major complication rate seems to be lower.
This treatment alternative is invasive and needs to be done in a surgical environment, under local anethesia.
The procedure involves a puncture (no incision) usually at the groin or the neck. Under x-ray guidance wires and catheters are navigated to the lung.
A catheter will be positioned into the clot and thrombolytic drip will be initiated. You will be transferred to the bedside and the drug will be delivered slowly over the course of 12-24 hours, until the heart and lung function have improved.
Modern techniques will even allow break up the clot into pieces or removal with suction through the catheter. As with any operation, catheter directed techniques have risks, mainly this of bleeding.