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Major blood clots are infrequent, but serious complications that can occur in neonatal intensive care. Most often, blood clots are related to catheters (thin tubes inserted into the body), especially those inserted into the torso, for instance umbilical catheters. These are used in treating or monitoring sick newborn babies. Sometimes blood clots do not cause symptoms, but symptomatic blood clots can impair circulation and result in damage in the arms, legs, lungs, kidneys, heart, brain or intestines. The most common treatments are observation (no treatment), anti‐clotting drugs (heparin), or clot‐dissolving drugs (streptokinase, urokinase, and TPA). Surgery is also sometimes done. Administration of clot‐dissolving drugs (thrombolytics) has a risk of causing severe bleeding. It is important to understand which treatment of blood clots produces the best short‐term and long‐term results. However, a search of the medical literature found no randomized clinical trials that compared clot‐dissolving drugs with other blood clot treatments in newborns. Thus, no conclusions could be drawn.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 24, 2005

There is no evidence available on the effect of clot dissolving drugs for intraventricular hemorrhage. About one‐sixth of all acute strokes are due to bleeding in the brain. Sometimes the blood enters the ventricles, the fluid‐filled spaces within the brain. This can block the circulation of fluid around the brain, causing rapid neurologic deterioration and even death. Fibrinolytic (or clot dissolving) treatment might help to break up blood clots, promote clearance of blood and reduce the risk of poor outcome. This review was not able to find sufficient good quality evidence from randomized trials to show whether this treatment does more good than harm. This therapy appears promising but further trials are needed to fully assess safety and efficacy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 22, 2002

Infected purulent pleural effusions (empyema) with isolated collections (loculations) of fluid or pus (complicated parapneumonic effusions) may develop with pneumonia. Drainage of this infected fluid via an intercostal catheter is important in healing. Evidence from seven randomised controlled trials (RCTs) with 761 participants indicates that flushing the pleural space with a fibrinolytic agent such as streptokinase or urokinase may help to break down the fibrinous bands or loculations that prevent total drainage of infected pleural fluid and therefore may significantly increase the amount of pus drained. Meta‐analysis of these RCTs indicates that intrapleural fibrinolytic therapy confers a benefit in reducing the requirement for surgical intervention for patients in some studies but not in others . The safety profile of intrapleural fibrinolytics remains uncertain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 23, 2008

Heart disease is the most common cause of death worldwide according to the World Health Organization. A heart attack can either be treated with a drug called a thrombolytic (clot buster) or with surgery. The earlier a thrombolytic is given, the less likely the individual is to die or have disabilities. Usually, thrombolysis is given in a hospital; however, the administration of this therapy before hospital, by paramedics, may be an effective intervention that may save time and reduce death and disability in people with heart attacks.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 10, 2014

Arteries can become clogged and narrowed with deposits of fat, cholesterol and other substances. This is called atherosclerosis and can cause heart attack. Two methods to open narrowed or clogged arteries in people who have had a recent heart attack are inserting a deflated small balloon in the artery and expand it to open the vessel (balloon angioplasty) or to insert a thin metal tube or sleeve (stent) into the artery to scaffold the artery open. This review compared these treatments and found both were equally effective at preventing death but using stents was better than balloon angioplasty because fewer arteries needed to be re‐cleared and stents prevented more heart attacks than balloon angioplasty.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 20, 2005

There is no good evidence on the effects of thrombolysis for cerebral vein thrombosis. Blood drains from the brain into the cerebral veins and then into the cerebral venous sinuses. If a clot forms in one of these blood vessels, it can cause headaches, seizures, loss of consciousness and other neurological symptoms. Clot dissolving treatments (thrombolytic therapy) could help to clear the clot and improve the patients' condition. However, thrombolytic therapy can cause serious or even fatal bleeding in the brain. The reviewers did not find any reliable evidence from randomised trials about the balance of risk and benefit from this treatment. Randomised controlled trials of this treatment are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 26, 2004

Clot busting drugs are effective at restoring blood flow in blocked leg arteries. Intravenous infusion (injection into veins) causes more haemorrhagic complications (risk of serious bleeding) than injection into arteries (arterial infusion). Acute reduction in blood flow to a limb (peripheral arterial ischaemia) is usually caused by a blood clot blocking an artery. The condition can be life threatening if not treated promptly. Infusion of clot‐busting drugs (thrombolysis) can restore blood flow by dispersing the clot. This review found evidence suggesting that arterial infusion is more effective than intravenous infusion. The risk of haemorrhage with intravenous infusion is high. However, none of the different arterial infusion techniques studied have been shown to be more effective in preventing limb loss, amputation or death. More research is needed to confirm these findings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 26, 2004

A pulmonary embolism is a potentially fatal blood clot that lodges in the main artery of the lungs, straining the right side of the heart and affecting blood circulation. Patients are also at risk of new embolisms forming (recurrence). In the case of a massive pulmonary embolism, treatment to restore blood flow is urgently required. Heparin thins the blood, but newer drugs that actively break up the clots (thrombolytics) may act more quickly and be more effective. These newer drugs include streptokinase, urokinase and recombinant tissue‐type plasminogen activator. The major complication of this treatment is bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 30, 2015

Deep vein thrombosis (DVT) occurs when a blood clot forms in a leg vein. The clot can break up and move to the lungs, leading to a potentially serious blockage in blood flow (pulmonary embolism or PE). Because of the damage to the leg vein, post‐thrombotic syndrome (PTS) may develop any time over the next couple of years. Symptoms include leg pain, swelling, skin pigmentation and leg ulcers, leading to loss of mobility. Anticoagulants are the standard treatment for DVT or a clot in a calf vein. These thin the blood to reduce further clots from forming and prevent PE; yet PTS can still develop. Thrombolysis breaks down the blood clot. For DVT, drugs such as streptokinase, urokinase and tissue plasminogen activator are infused into a vein in the arm or foot or, in some cases, directly at the site of the clot using a catheter and X‐ray control. Bleeding complications, stroke or intracerebral haemorrhage are potential harmful events for both treatments.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 10, 2016

We wanted to compare the safety and efficacy of clot‐dissolving (thrombolytic) drugs versus placebo or no treatment in the early stages of ischaemic stroke to see if clot‐dissolving drugs improve outcome after stroke.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 29, 2014

Deep vein thrombosis (DVT) occurs when a blood clot blocks the flow of blood through a vein, generally in the legs. This can happen after surgery, after trauma, when a person is immobile for a long time, or for no obvious reason. Clots can dislodge and block blood flow to the lungs (pulmonary embolism (PE)), which can be fatal. DVT and PE are known as venous thromboembolism (VTE). Heparin is a blood‐thinning drug that is used to treat DVT during the first three to five days. Unfractionated heparin (UFH) is administered intravenously in hospital with laboratory monitoring. Low molecular weight heparins (LMWHs) are given by subcutaneous injection once a day and can be given at home. Oral anticoagulants are then continued for three to six months. After recovery from the acute episode, people may develop post‐thrombotic syndrome with leg swelling, varicose veins, and ulceration.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2018

Thrombolysis involves dissolving a blood clot by injecting an enzyme into the blood clot. It is used as an alternative to surgery for managing severely reduced blood flow (acute ischaemia) in the leg. A blood clot (thrombosis) forms in a leg blood vessel where there is severe narrowing (stenosis) in a natural artery or a bypass graft.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 6, 2013

Acute reduction in blood flow to a limb can be caused by a blood clot blocking an artery or a vascular graft. If not treated promptly this condition, known as peripheral arterial occlusion, can result in amputation or be life threatening. Infusion of clot‐busting drugs can restore blood flow by dissolving the clot (thrombolysis). This review found some evidence from five randomized controlled trials, involving a total of 687 patients that suggested local infusion of a drug into the affected artery is more effective than infusion into a vein, and is also associated with a lower risk of unwanted bleeding. No particular drug was more effective in preventing limb loss or death than another. The drugs investigated were streptokinase, urokinase, recombinant tissue plasminogen activator and pro‐urokinase. More research is needed to confirm these findings. All of the findings of this review came from small studies that involved people with peripheral arterial ischaemia of differing severity.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 19, 2013

Many strokes are due to a sudden blockage of an artery in the brain. Treatments to dissolve the clot (also called thrombolytic treatment) can improve the chance of making a good recovery from a stroke. This review aimed to find out if there were important differences between different clot‐dissolving drugs. It also aimed to find out if there were differences in effect when giving the same drug in different doses or by different routes (into an artery or a vein). The review, which included 20 studies involving 2527 participants, showed that there was some evidence that lower doses of thrombolytic agents led to serious bleeding in the brain less often. However, it was not clear if the benefit from lower doses was as big as with higher doses. There was no evidence to show that one thrombolytic agent was clearly better than another, or that intra‐arterial treatment was better than intravenous treatment. Therefore, more larger randomised controlled trials are required to answer questions about which drug, or dose or route of administration is best for thrombolysis. At present, rt‐PA as currently licensed in many countries, should be regarded as best practice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 31, 2013

A blood clot can block a venous blood vessel to cause what is known as a thromboembolism. This most often occurs in a leg (deep vein thrombosis) or in the lungs (pulmonary embolism), which can be fatal. Once formed, a blood clot in a leg can increase in size or can move to the lungs and the recommended treatment is to give drugs that thin the blood (anticoagulants). These include heparins and drugs that inhibit the action of vitamin K (warfarin, phenprocoumon, and acenocoumarol). The possible harms caused by anticoagulants include bleeding in the gut or brain and anticoagulant‐induced clotting. The review authors made a thorough search of the medical literature looking for controlled studies on people with blood clots in their veins comparing blood thinning drugs (anticoagulants) with drugs to reduce inflammation (non‐steroidal anti‐inflammatory drugs) or dummy treatment (placebo). Only two small studies with a total of 113 participants treated over three months were identified, which gave inconclusive results. Since the use of anticoagulants is widely accepted in clinical practice, designing and implementing other similar studies would not be ethical.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 25, 2006

The most common symptom of chronic lower limb ischaemia (inadequate blood flow to the legs) is claudication, a cramping pain caused by a poor supply of blood to the affected muscle. It often affects the calf muscle, and is typically triggered by exercise and relieved by rest. More severe restriction of the blood supply may produce pain at rest, leg ulcers, or gangrene. These conditions, and severe claudication, may require bypass surgery or other treatments to improve blood flow to the leg.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 3, 2017

Question: We wanted to compare the safety and effectiveness of transcatheter device closure (TDC) versus medical therapy in people with a patent foramen ovale (PFO) who have suffered a stroke of unknown cause in order to prevent strokes or similar events occurring again.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 8, 2015

Pregnancy complications such as pre‐eclampsia and eclampsia, intrauterine fetal growth restriction and placental abruption are thought to be related to abnormalities in the development and function of the placenta. Treatment with heparin to prevent the development of blood clots within the placenta appears to be a promising intervention to prevent these complications. The numbers of pregnant women with pre‐eclampsia, preterm birth, perinatal death and a low birthweight infant (weighing less than the 10th centile for gestational age) were reduced with this treatment. Ten randomised trials involving 1139 women met the inclusion criteria for the review. Nine studies compared heparin (alone or in combination with dipyridamole) with no treatment; and one compared triazolopyrimidine with placebo. The most commonly recognised side effect for women related to this treatment was mild skin bruising. To date, important information about serious adverse infant and long‐term childhood outcomes with using anti‐clotting medications is unavailable. Further research is required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 24, 2013

The majority of disabling strokes are due to blockage of a large artery in the brain by a blood clot. For these patients, the most intuitive means of treatment is removal of the blockage by either injecting clot‐dissolving (thrombolytic) drugs directly into the clot or removal of the clot using a mechanical device, or both. Prompt treatment can restore blood flow before major brain damage has occurred, leading to a good recovery. However, these treatments can also cause bleeding in the brain with poorer outcomes. This review of four trials involving 350 participants indicated that this form of treatment can remove large artery blood clots and improve the chances of good recovery despite an increased risk of bleeding in the brain. Long term risk of death is unaffected. However, it is still not clear what the time window is within which treatment is beneficial, what types of arterial blockage are most likely to respond, whether mechanical devices are effective, and whether any of these treatments are better than standard intravenous thrombolytic drugs. More information is needed from forthcoming randomised trials to answer these questions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 6, 2010

Venous leg ulcers are a common, recurring and disabling condition. The mainstay of treatment is the use of firm compression bandages or stockings to support the veins of the leg. Some leg ulcers take many months or years to heal and treatment is aimed at preventing infection and speeding up healing. Pentoxifylline is a tablet taken to improve blood circulation. The review of trials suggests that pentoxifylline, 400 mg tablet taken three times a day, increases the chance of healing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 12, 2012

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