In terms of specificity to fibrin, which agent is preferred for thrombolysis?

The preferred agent for thrombolysis in terms of specificity to fibrin is Tenecteplase. This agent is a genetically modified form of tissue plasminogen activator (tPA) that has been designed to have increased fibrin specificity compared to other thrombolytic agents. This means that Tenecteplase more effectively targets and degrades fibrin in a clot, enhancing its efficacy in treating conditions such as acute myocardial infarction.

The increased fibrin specificity of Tenecteplase leads to a lower risk of systemic bleeding since it preferentially acts on the fibrin within a thrombus rather than dissolving plasminogen circulating in the bloodstream. This trait contributes to its favorable therapeutic profile and makes it a more suitable option in acute thrombolytic therapy.

Other agents, while effective for thrombolysis, do not demonstrate the same level of specificity for fibrin. For example, Alteplase, while also a tPA, has a higher tendency to activate plasminogen in the plasma, which can increase the risk of bleeding complications. Streptokinase, a non-fibrin-specific thrombolytic agent, activates plasminogen regardless of clot presence, making it less desirable when aiming for localized clot lysis.