Plasminogen activation and thrombolysis for ischemic stroke

Int J Stroke. 2012 Jul;7(5):419-25. doi: 10.1111/j.1747-4949.2012.00783.x. Epub 2012 Mar 30.


The plasminogen-activating enzyme system has been exploited and harnessed for therapeutic thrombolysis for nearly three decades. Tissue-type plasminogen activator is still the only thrombolytic agent approved for patients with ischemic stroke. While tissue-type plasminogen activator-induced thrombolysis is proven to be of clear benefit in these patients if administered within 4·5 h poststroke onset, it is surprisingly underused in clinics despite international guidelines and improved acute stroke systems, a situation that requires urgent attention. While tissue-type plasminogen activator has also been shown to have unforeseen roles in the brain that have presented new challenges, tissue-type plasminogen activator and related fibrinolytic agents are currently being assessed over extended time frames. This review will focus on the therapeutic experience and controversies of tissue-type plasminogen activator. Furthermore, we will also provide an overview of recent and current trials assessing tissue-type plasminogen activator and related thrombolytic agents as well as novel approaches for the treatment of ischemic stroke.

Publication types

  • Review

MeSH terms

  • Animals
  • Brain / metabolism
  • Brain Ischemia / drug therapy*
  • Clinical Trials as Topic
  • Disease Models, Animal
  • Fibrinolysis / physiology
  • Fibrinolytic Agents / pharmacology
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Infusions, Intravenous
  • Meta-Analysis as Topic
  • Mice
  • Stroke / drug therapy*
  • Thrombolytic Therapy / methods
  • Tissue Plasminogen Activator / metabolism
  • Tissue Plasminogen Activator / pharmacology
  • Tissue Plasminogen Activator / therapeutic use*


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator