Clinical pharmacology of coronary thrombolysis

Pharmacologic thrombolysis is dependent on activation of endogenous plasminogen to the active proteolytic enzyme, plasmin. Agents such as tissue-plasminogen activator with a high affinity for fibrin bound plasminogen result in high local concentration of plasmin. Thus, they achieve clot lysis with less tendency to induce a systemic lytic state reflecting extensive fibrinogenolytic activity in the circulation. Appropriate dose regimens for thrombolytic agents in specific clinical situations is critical to maximize therapeutic efficacy while minimizing the risk of significant bleeding.