Pharmacological Fibrinolysis

Until fairly recently, arteriosclerosis and its complications were philosophically accepted as an inevitable consequence of ageing; but the steady increase of coronary deaths in particular, and the equally steady decrease ^ the age of onset have put an end to such laissez-faire complacency. To Pinpoint the epidemic acceleration of coronary deaths, a senior colleague told me that when he took the membership in 1927 there was a question on coronary thrombosis, and surprising as it may seem a good many of the candidates had not heard of the condition. Now, whilst it is difficult to see the wood for the trees, what we are witnessing may be an increase more of vascular occlusion than of arterio-sclerosis. William Heberden described angina pectoris 180 years ago, and 19th century pathologists were well aware of arteriosclerosis in all its forms. And yet myocardial infarction escaped recognition in this country until 1925 (Gibson, 1925; McNee, 1925). Or did it? Perhaps before then it was not at all common. It seems unlikely that the excellent morbid histologists at the turn of the century would have missed it if it were occurring with any frequency. If this be true, despite the multifactorial nature of the problem, perhaps We should be concerned primarily with the prevention of thrombosis, in other words with the circulating fluid, the blood. The situation, however, [emains multifactorial because it involves at least three factors, platelet behaviour, coagulation, and last, though I hope not least, fibrinolysis. It is with fibrinolysis that I have been especially concerned, and particularly with !ts enhancement by drugs given orally, which also influence platelet sticki-ness, plasma fibrinogen level, and serum cholesterol, thus, as it were, killing several associated birds with one stone.