What is the historical background of thrombolytic therapy?

Updated: Dec 31, 2017
  • Author: Wanda L Rivera-Bou, MD, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

The history of thrombolytic therapy began in 1933, when it was discovered that filtrates of broth cultures of certain streptococcal strains (beta-hemolytic streptococci) could dissolve a fibrin clot. [1] Streptokinase found its initial clinical application in combating fibrinous pleural exudates, hemothorax, and tuberculous meningitis. [2] In 1958, streptokinase was first used in patients with acute myocardial infarction (AMI), and this changed the focus of treatment.

Streptokinase infusion initially yielded conflicting results until the Gruppo Italiano per la Sperimentazione della Streptochinasi nell’Infarto Miocardico (GISSI) trial in 1986, which validated streptokinase as an effective therapy and established a fixed protocol for its use in AMI. [2]

The fibrinolytic potential of human urine was first described in 1947, and the active molecule was named urokinase. [1] Unlike streptokinase, urokinase is not antigenic and directly activates plasminogen to form plasmin. The ability of these substances to catalyze the conversion of plasminogen to plasmin is affected only slightly by the presence or absence of local fibrin clot.


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