Well Sumeet ..

May be one of the reasons depend on the alteplase capacity as a fibrinolytic to work in fibrin clots whether thin or thick clots ..

Carr ME, Jr, and Alving BM. Effect of fibrin structure on plasmin-mediated dissolution of plasma clots. Blood Coagul Fibrinolysis. 1995; 6 (6): 567–573.

Thank you very much Tamer.

An interesting paper and way to look at Alteplase activity.

Thanks again...this still doesn't really explain why the thrombi formed from some patients was responsive to Alteplase; and in some not.

Sumeet Gulati

There are many factors that differ in each patient.

For example, the nature of the clot. As far as I know, there are no good data of pathological report from the alteplase failure patients. Alteplase works with "blood clot" but not another type for instance tumour emboli.

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Thank you Jukrapope.

I actually used blood samples from 3-4 donors to form blood clots in vitro, then subjected them to lysis using Alteplase. Some of the donors subsequently did not respond. Someone mentioned to me a while back that, around 30% of patients do not respond to this particular thromobolytic therapy. I'm trying to find an explanation that correlates more with this context.

Appreciate your reply, thrombi due to hypercoagulative state because of an underlying tumour is also an interesting digression.

Sorry I didn't read your first question. I thought in vivo situations.

I guess clot size may play a role in vitro. In your sitting surface area might be the key. In large clot, alteplase might not diffuse trough out the clot.

They are all uniform clots and less than 8mm.

Good work, colleague and I think it will have a great impact on guidelines of IV thrombolysis.

To my mind , many factors interfere with IVT response beyond the time window and length of the thrombus.

They also include the nature of the thrombus as not all of them are formed of fibrin e.g. the white thrombus may contain tough tissue which may be detached from mitral valves