Combining antithrombotic and fibrinolytic agents: can it be done?

M ore than half of ischemic stroke patients who are treated with IV recombinant tissue-type plasminogen activator (rtPA) remain disabled at 3 months. The reasons are many. The IV rtPA rate of recanalizing occluded arteries is not as high as we would like, especially for large arterial occlusions, which are opened only 30% to 40% of the time. 3–6 When rtPA does effectively lyse a thrombus, it is sometimes too late; permanent tissue injury may have already occurred.