New directions in thrombolytic therapy

The currently available thrombolytic agents are widely perceived to be suboptimal in terms of both efficacy and safety. This perception has in turn stimulated efforts to design and construct novel plasminogen activators endowed with improved biochemical and pharmacologic properties. There is as yet no consensus as to the properties of an “ideal” thrombolytic agent, and the failure of comparative clinical trials to identify a superior agent has contributed to the controversy. Although an improved plasminogen activator has not yet been constructed, it is clear that efforts to do so have advanced our knowledge of the complex structure-function relationships within plasminogen activators.