Misunderstanding Fibrinolysis Has Done Serious Damage

Gurewich V

Published on: 2022-07-20


Both an acute myocardial infarction (AMI) and ischemic stroke are caused by an occlusive thrombus or blood clot in either the coronary circulation or in the neck or head in the case of an ischemic stroke. These are both cardiovascular emergencies since the ischemic changes become irreversible unless reperfusion takes place within a certain period of time. The fastest reperfusion method by far is fibrinolysis, which can be initiated without delay. Unfortunately, fibrinolysis became the victim of a misunderstanding. It was believed that fibrinolysis was due to the effects of tissue plasminogen activator (tPA), which became the treatment of choice for AMI and some ischemic strokes. Since tPA does not degrade fibrin, it is not a fibrinolytic, and so was ineffective in these studies. Instead of correcting how fibrinolysis was induced, it was abandoned and replaced by a much are much slower and less refined mechanical treatment. These interventional procedures like percutaneous coronary intervention (PCI) or angioplasty have replaced fibrinolysis. These procedures often require hospitalization and can only open vessels larger than the catheter. Instead of fibrinolysis, this is a woefully inadequate treatment for a cardiovascular emergency.