Third-generation thrombolytic drugs

Several third-generation thrombolytic agents have been developed. They are either conjugates of plasminogen activators with monoclonal antibodies agai nst fibrin, platelets, or thrombomodulin; mutants, variants, and hybrids of alteplase and prourokinase (amediplase); or new molecules of animal (vampi re bat) or bacterial (Staphylococcus aureus) origin. These variations may l engthen the drug's half-life, increase resistance to plasma protease inhibi tors, or cause more selective binding to fibrin. Compared with the second-g eneration agent (alteplase), third-generation thrombolytic agents such as m onteplase, tenecteplase, reteplase, lanoteplase, pamiteplase, and staphylok inase result in a greater angiographic patency rate in patients with acute myocardial infarction, although, thus far, mortality rates have been simila r for those few drugs that have been studied in large-scale trials. Bleedin g risk, however, may be greater. Am J Med. 2000;109:52-58. (C) 2000 by Exce rpta Medica, Inc.