On the association of elevated tPA/PAI-1 complex and von Willebrand factor with recurrent myocardial infarction.

For a long time, we have known that a decrease in fibrinolytic activity is linked to an increase in risk of myocardial infarction.1–3 Paradoxically, the most convincing association between fibrinolysis and cardiovascular risk was an increased level of the profibrinolytic enzyme itself, tissue plasminogen activator (tPA).4,5 This unexpected finding was said to be due to the methods of measurement, which were unable to distinguish free tPA from tPA complexed with various inhibitors, the most important one being plasminogen activator inhibitor 1 (PAI-1), but this explanation had never been proven.