There is firm evidence that reperfusion therapy, to be effective must establish and maintain coronary arterial blood flow at a level sufficient to allow myocardial perfusion. However, current thrombolytic regimens have clear limitations, including a relatively low capacity to achieve TIMI Grade 3 blood flow and an unacceptable incidence of coronary reocclusion. Although it has been assumed that the key to achieving optimal reperfusion lies with adjunctive antithrombotic therapy, it may be that novel thrombolytics and dosing strategies can address the problem adequately. This possibility is attractive and requires careful consideration. © 1995 Kluwer Academic Publishers.