Reteplase, a new third generation thrombolytic agent

Since the discovery of thrombus formation as the main culprit in acute myocardial infarction, vigorous attempts to develop potent, yet safe, thrombolytic agents that would reperfuse infarct arteries and halt the progression of myocardial injury have seen pursued. Several agents have since been developed and introduced into clinical practice. Until recently, the main thrombolytic agent in clinical use has been t-PA, which has been shown to be both efficacious and safe. However, TIMI-3 flow was observed in only 50% of patients receiving t-PA in large multicenter trials. In addition, present administration protocols are cumbersome, despite abbreviated front-loaded regimens. Recently, r-PA was developed and was found to have higher TIMI-3 flow when administered in a simpler double bolus regimen with an equivalent safety profile to that of t-PA.