[Fibrinolysis modulators]

The structure of fibrin network and the properties of the fibrinolytic enzymes (the formation, the efficiency of their activity and the rate of their inactivation) essentially determine the effectiveness of fibrinolysis. The fibrin structure and the action of proteases, however, depend considerably on additional physiological and pathological conditions. These are: cell membrane and components of endothelial cell, elastase of polymorphonuclear cells, actin and myosin in thrombus released by platelets and smooth muscle cells, certain denatured proteins, various immunoglobulins, some metabolites accumulated in diabetes mellitus, the inhibitor system of fibrinolytic enzymes (where and when proteases are available for inhibitors). In this survey, the biochemical basis makes understandable for the medical practitioner why urgent fibrinolytic therapy is required and why it would be ideal to initiate the formation of fibrinolytic enzymes at the site of thrombus.