Tissue Plasminogen Activator (t-PA)

IN an unsigned editorial published in the Journal of the American Medical Association 25 years ago, entitled "Requirements for an Ideal Thrombolytic Agent," I concluded, "Thus, an ideal thrombolytic agent would be specific for effecting clot dissolution, adequately standardized, and capable of being given to patients without significant hazard...."1 The plasminogen activators streptokinase and urokinase, which subsequently became available for clinical use, were shown to be effective in dissolving thrombi and emboli but were not specific for fibrin. They activated plasminogen in the circulation as well as that bound to fibrin; whereas the latter action was responsible for clot dissolution, . . .