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Can treatment of thrombus cause embolism, in case of very high blood pressure, that may even lead to a heart attack ?

As the very high Blood pressure may cause some of the enzymes not act completely on the thrombus and release emboli in the blood stream ?

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    $\begingroup$ Which treatment of thrombus are you talking about? Angioplasty or thrombolytics? $\endgroup$ – Spinorial Jun 18 '14 at 13:51
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Yes, treatment of thrombus can cause embolism. Hypertension favors hemorrhagic complications.

Thrombolytics:

Yes, they can cause paradoxical embolism, although it is a rare complication [1]. The most fearful complication of thrombolytic medication is major hemorrhage. And hypertension favors bleeding [2].

Catheter-directed thrombolysis:

Hypertension (more than 180 mmHg and associated with congestive heart failure) was found to increase hemorrhagic complications [3].

Angioplasty:

Angioplasty produces some embolic particles [4]. However, using embolic protection is disputed [4, 5].


References:

  1. Liu YF, Bayliss M. Paradoxical embolism: a rare complication of thrombolysis. Emerg Med J. 2008 Mar;25(3):180-1. doi: 10.1136/emj.2007.053934. PubMed PMID: 18299379.

  2. Meneveau N, Vuillemenot A, Bassand JP. [Complications of thrombolytic therapy in pulmonary embolism]. Arch Mal Coeur Vaiss. 1995 Nov;88(11 Suppl):1769-76. PubMed PMID: 8815838.

  3. Agle SC, McNally MM, Powell CS, Bogey WM, Parker FM, Stoner MC. The association of periprocedural hypertension and adverse outcomes in patients undergoing catheter-directed thrombolysis. Ann Vasc Surg. 2010 Jul;24(5):609-14. doi: 10.1016/j.avsg.2009.12.011. PubMed PMID: 20413257.

  4. Malik RK, Landis GS, Sundick S, Cayne N, Marin M, Faries PL. Predicting embolic potential during carotid angioplasty and stenting: analysis of captured particulate debris, ultrasound characteristics, and prior carotid endarterectomy. J. Vasc. Surg. 2010 Feb;51(2):317-22. doi: 10.1016/j.jvs.2009.08.063. PubMed PMID: 20006918.

  5. Divani AA, Berezina TL, Zhou J, Pakdaman R, Suri MF, Qureshi AI. Microscopic and macroscopic evaluation of emboli captured during angioplasty and stent procedures in extracranial vertebral and internal carotid arteries. J. Endovasc. Ther. 2008 Jun;15(3):263-9. doi: 10.1583/07-2326.1. PubMed PMID: 18540698.

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    $\begingroup$ Those complications which the above mentions is not necessarily talking about due to embolic events, the tPA interferes with clotting and as such can lead to events such as haemorrhagic stroke. But yes thrombolitics can cause emboli. Using the treatment is weighing up the effects of ischaemia due to the thrombus vs risk of the treatment. $\endgroup$ – Spinorial Jun 18 '14 at 17:28

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