Why so little progress in therapeutic thrombolysis? The current state of the art and prospects for improvement

Thrombosis is a major contributor to disability and mortality worldwide and is estimated to be the cause of one in four deaths [ 1 ]. It is the pathology responsible for triggering acute myocardial infarction (AMI) and ischemic stroke, and is the primary cause of venous thromboembolism. The pathogenesis has been well-studied starting with Virchow more than 150 years ago [ 2 ], and its prevention by anti-thrombotic drugs has made much progress, culminating most recently in the approval of new oral anticoagulants which are specific inhibitors of thrombin or factor Xa.