Mechanism of action of fibrinolytic enzymes in vivo.

Plasminogen-rich and plasminogen-poor radiolabeled human fibrin clots were inserted into large veins of baboons and stump-tailed monkeys. The thrombolytic effects of plasminogen activators (urokinase, streptokinase), and plasmin preparations with activator activity (streptokinase-activated human plasmin) and without activator activity (trypsin-activated porcine plasmin, Lysofibrin) were studied. Plasminogen-free and plasminogen-rich clots lysed at equal rates. Preparations with and without activator activity were equally effective as thrombolytic agents. Endogenous activation of plasminogen in the clot thus appears not to be the essential mechanism of thrombolysis. The exogenous pathway of enzyme adsorption to fibrin fibers seems to represent an important thrombolytic mechanism. Clot lysis was achieved with doses of fibrinolytic enzymes which produced little or no significant hematologic changes including hypofibrinogenemia and decreases of other blood coagulation factor levels.