Cellular and molecular mechanisms of thrombosis and thrombus-targeted thrombolytic strategies

The formation of thrombus is intricately linked to the development of severe cardiovascular diseases, including myocardial infarction, stroke, deep vein thrombosis, pulmonary embolism, and peripheral vascular diseases. Despite advancements in thrombolytic therapy, challenges still exist regarding thrombus targeting and treatment safety, as excessive doses of thrombolytic agents often lead to complications such as bleeding and neurotoxicity. A thorough understanding of the cellular and molecular mechanisms underlying thrombosis is critical for the development of safer and more effective thrombolytic strategies. It is widely acknowledged that various cells and key molecules play significant roles in thrombus formation. Building on this knowledge, a series of thrombus-targeted thrombolytic strategies have been developed, focusing on the targeted delivery and localized release of thrombolytic agents at the site of the thrombus. This review first summarizes the roles of cells and molecules in thrombus formation and provides a comprehensive overview of the classical cellular and molecular mechanisms of thrombosis. Furthermore, we explore the latest advancements in thrombus-targeted thrombolytic strategies, which are grounded in the critical cells and molecules associated with thrombosis. Finally, we conclude with a brief discussion of potential future directions in this emerging field.