Thrombolytic therapy in morbidly obese patients

Most of the concern about dosing thrombolytic agents as presented in the literature is related to the lower weight groups and the increased incidence of bleeding in this patient population. Not much is known or written about what dose of thrombolytic therapy should be used in the grossly obese patient with an AMI. Although it may be uncommon to have a morbidly obese patient with an AMI, it does occur. Perhaps body weight doesn't matter since we are really dosing the clot and not the body, but, as far as I can discern, there are no data regarding dosing of thrombolytic drugs to guide the clinician managing these patients.