New developments in thrombolytic therapy

Pharmacologic lysis of occlusive, ischemia-producing thrombi has become widely accepted during the past decade. New developments in this field have centered around increasing the efficacy of the known plasminogen activators while employing methods to minimize the risk of hemorrhage and decrease the incidence of rethrombosis. Such methods have included the use of thrombus-directed antibodies linked to plasminogen activators, increased plasminogen (substrate) concentration at the thrombus site, anticoagulant and antiplatelet therapy to prevent thrombus propagation and reformation following lysis, and combination plasminogen activator therapy designed to increase efficacy and safety. These new strategies have been extensively tested in vitro and in a variety of animal models. As we have indicated, extrapolation of such results to human patients cannot be done with confidence. However, the strategies are based on sound rationale and the reported findings should serve as the basis for controlled human trials.