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Thrombolytic therapy efficacy in cardiopulmonary resuscitation: Investigating the effect of recombinant tissue plasminogen activator (Review)

  • Authors:
    • Wenbin Zhang
    • Yinpng Pan
    • Jian Ding
    • Dexin Xu
    • Wenhai Wang
  • View Affiliations / Copyright

    Affiliations: Department of Cardiology, Jilin Province FAW General Hospital, Changchun, Jilin 130000, P.R. China, Department of Pediatrics, Jilin Province FAW General Hospital, Changchun, Jilin 130000, P.R. China, Department of Electrodiagnosis, Jilin Province FAW General Hospital, Changchun, Jilin 130000, P.R. China, Department of Orthopedics, Jilin Province FAW General Hospital, Changchun, Jilin 130000, P.R. China
    Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 335
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    Published online on: October 1, 2025
       https://doi.org/10.3892/mmr.2025.13700
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Abstract

Cardiopulmonary resuscitation (CPR) involves a series of urgent life‑saving actions performed to manually revive a person in cardiac arrest. In >70% of CPR cases, the primary health deterioration is due to acute myocardial infarction or a significant pulmonary embolism. Fibrinolytic therapy, also known as thrombolytic treatment, functions by dissolving dangerous intravascular clots to mitigate ischemic damage through improved blood circulation. Thrombolytic therapy has emerged as a promising intervention within the context of CPR for patients experiencing cardiac arrest. Recombinant tissue plasminogen activator (rtPA) is a bioengineered version of a natural enzyme that converts plasminogen into plasmin, an enzyme essential for clot dissolution. The efficacy of rtPA in thrombolytic therapy for CPR suggests its potential as a valuable clinical tool. The present comprehensive review assessed the efficacy and safety of rtPA administration during CPR, focusing on outcomes such as survival rates, neurological function and potential complications. It also explored the underlying mechanisms by which rtPA may enhance reperfusion and improve patient outcomes, including clot dissolution, myocardial salvage and microcirculatory improvements. Additionally, it examined the optimal timing and dosing strategies for rtPA administration and its integration with standard CPR protocols and other supportive therapies.
View Figures

Figure 1

Mechanisms of rtPA in CPR. From clot
formation to the restoration of normal blood flow, rtPA plays a
critical role in enhancing patient outcomes during cardiac
emergencies. Created with BioRender.com. rtPA, recombinant tissue
plasminogen activator; CPR, cardiopulmonary resuscitation; uPA,
urokinase plasminogen activator; PAI-1, plasminogen activator
inhibitor-1.

Figure 2

The potential benefits of
thrombolytic therapy, particularly rtPA, in improving rates of ROSC
during CPR are highlighted. It emphasizes observed outcomes, such
as increased ROSC rates and early survival, while also addressing
significant challenges and limitations, including the risk of
bleeding complications, variable patient responses and logistical
hurdles in therapy administration. Together, these elements
underscore the complex considerations that healthcare providers
must navigate when integrating thrombolytic therapy into CPR
protocols. Created with BioRender.com. rtPA, recombinant tissue
plasminogen activator; ROSC, return of spontaneous circulation;
CPR, cardiopulmonary resuscitation.
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Copy and paste a formatted citation
Spandidos Publications style
Zhang W, Pan Y, Ding J, Xu D and Wang W: Thrombolytic therapy efficacy in cardiopulmonary resuscitation: Investigating the effect of recombinant tissue plasminogen activator (Review). Mol Med Rep 32: 335, 2025.
APA
Zhang, W., Pan, Y., Ding, J., Xu, D., & Wang, W. (2025). Thrombolytic therapy efficacy in cardiopulmonary resuscitation: Investigating the effect of recombinant tissue plasminogen activator (Review). Molecular Medicine Reports, 32, 335. https://doi.org/10.3892/mmr.2025.13700
MLA
Zhang, W., Pan, Y., Ding, J., Xu, D., Wang, W."Thrombolytic therapy efficacy in cardiopulmonary resuscitation: Investigating the effect of recombinant tissue plasminogen activator (Review)". Molecular Medicine Reports 32.6 (2025): 335.
Chicago
Zhang, W., Pan, Y., Ding, J., Xu, D., Wang, W."Thrombolytic therapy efficacy in cardiopulmonary resuscitation: Investigating the effect of recombinant tissue plasminogen activator (Review)". Molecular Medicine Reports 32, no. 6 (2025): 335. https://doi.org/10.3892/mmr.2025.13700
Copy and paste a formatted citation
x
Spandidos Publications style
Zhang W, Pan Y, Ding J, Xu D and Wang W: Thrombolytic therapy efficacy in cardiopulmonary resuscitation: Investigating the effect of recombinant tissue plasminogen activator (Review). Mol Med Rep 32: 335, 2025.
APA
Zhang, W., Pan, Y., Ding, J., Xu, D., & Wang, W. (2025). Thrombolytic therapy efficacy in cardiopulmonary resuscitation: Investigating the effect of recombinant tissue plasminogen activator (Review). Molecular Medicine Reports, 32, 335. https://doi.org/10.3892/mmr.2025.13700
MLA
Zhang, W., Pan, Y., Ding, J., Xu, D., Wang, W."Thrombolytic therapy efficacy in cardiopulmonary resuscitation: Investigating the effect of recombinant tissue plasminogen activator (Review)". Molecular Medicine Reports 32.6 (2025): 335.
Chicago
Zhang, W., Pan, Y., Ding, J., Xu, D., Wang, W."Thrombolytic therapy efficacy in cardiopulmonary resuscitation: Investigating the effect of recombinant tissue plasminogen activator (Review)". Molecular Medicine Reports 32, no. 6 (2025): 335. https://doi.org/10.3892/mmr.2025.13700
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