Effective and Safe Fibrinolysis Requires both Plasminogen Activators in a Sequential Combination

A clot that obstructs blood flow triggers the onset of most heart attacks and 85% of strokes, the leading causes of death and disability worldwide. Reestablishing blood flow rapidly limits damage to the heart or brain, saves lives, and can restore well-being. Since “time is heart or brain,” treatment must be initiated rapidly, which means by a readily available method. Fibrinolysis is the only therapy able to fulfill these criteria but the current method using tissue Plasminogen Activator (tPA) monotherapy is not sufficiently safe to be administered without pre-testing nor is it sufficiently effective to be very useful. Although anticoagulants have evolved, especially in recent years, the same thrombolytic has been used since 1987, when tPA monotherapy was approved for the treatment of Acute Myocardial Infarction (AMI) and subsequently also for ischemic stroke.