Thrombotic vascular occlusion is the leading cause of ischemic stroke. High blood levels of α2-antiplasmin, an ultrafast, covalent inhibitor of plasmin, have been linked in humans to increased risk of ischemic stroke and failure of tissue plasminogen activator therapy. Consistent with these observations, α2-antiplasmin neutralizes the therapeutic benefit of tissue plasminogen activator therapy in experimental stroke. In addition, α2-antiplasmin has deleterious, dose-related effects on ischemic brain injury in the absence of therapy. Experimental therapeutic inactivation of α2-antiplasmin markedly reduces microvascular thrombosis, ischemic brain injury, brain swelling, brain hemorrhage and death after thromboembolic stroke. These data provide new insights into the critical importance of α2-antiplasmin in the pathogenesis of ischemic brain injury and suggest that transiently inactivating α2-antiplasmin may have therapeutic value in ischemic stroke.