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**THR-18 + alteplase** is an investigational combination therapy that pairs THR-18, a synthetic peptide fragment derived from plasminogen activator inhibitor-1 (PAI-1), with alteplase (recombinant tissue plasminogen activator, rtPA). THR-18 is designed to reduce or neutralize the life-threatening adverse effects associated with alteplase, such as intracranial hemorrhage (ICH) and brain edema, by binding to a docking site on tPA. This interaction aims to preserve the clot-dissolving action of alteplase while minimizing its harmful non-fibrinolytic effects on the blood vessel wall. Clinical studies indicate the combination is being developed primarily for use in acute ischemic stroke, aiming to improve neurological outcomes and lower the incidence of hemorrhagic complications.
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