Making Thrombolysis Safer In Stroke

Thrombolytic therapy with tissue plasminogen activator (tPA) was approved by the US Food and Drug Administration for treatment of acute ischemic stroke in 1996 and remains the only approved pharmacologic treatment for this condition. 1 Although considered the standard of care, tPA is underused in stroke patients for several reasons, including the strict eligibility criteria, narrow treatment window, and risk of life-threatening bleeding.(1,2) In this issue of Blood, Simao et al present findings using a mouse model of cerebral ischemia-reperfusion injury that indicate some adverse effects of tPA therapy in stroke patients may be mitigated by blocking the protease plasma kallikrein (PKal).(3)