Inhibition of Clot-Bound a2-Antiplasmin Enhances In Vivo Thrombolysis

Recent experiments in vitro have shown that inhibition of human ci2-antiplasmin by a monoclonal antibody (MAb RWR) markedly enhances clot lysis by plasminogen activators. To extend these studies in vivo, we tested whether inhibition of clot or fibrin-bound o2-antiplasmin by MAb RWR could enhance the lysis of a human clot by tissue-type plasminogen activator (t-PA) in a rabbit jugular vein thrombosis model. Compared with a saline placebo or a control antibody, MAb RWR significantly increased thrombolysis by endogenous plasminogen activator in rabbits to which no t-PA was administered (p<0.05). In rabbits that received t-PA, the combination of MAb RWR and t-PA caused significantly greater thrombolysis than equivalent doses of t-PA alone (p<0.05). However, compared with equipotent doses of t-PA alone, the combination ofMAb RWR and t-PA did not increase the nonspecific consumption of fibrinogen. These experiments suggest that the combination of an a2-antiplasmin inhibitor and a plasminogen activator could be a more potent thrombolytic strategy. (Circulation 1990;82:164-168)