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Why does thrombolysis fail? Breaking through the reperfusion ceiling.

With best current regimens, thrombolysis may initially fail in 15% to 40% of cases because of hemodynamic or mechanical factors, inadequate fibrinolysis, or failure to lyse platelet-rich thrombi. Pathophysiologic considerations and early experimental and clinical trials suggest that improved conjunctive antiplatelet therapy (as with glycoprotein IIb/IIIa inhibitors) and, possibly, more effective antithrombins (low molecular weight heparins, hirudin) may allow this thrombolysis "ceiling" to be broken and the goal achieved of reperfusion rates closer to those of primary angioplasty.