Abstract-Glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors were shown recently to facilitate the rate and the extent of pharmacological thrombolysis. However, their synergistic potential with rtPA in dissolving thrombotic vaso-occlusions is not fully understood. We have therefore developed a dynamic and structural approach for analysis of fibrinolysis to assess the inhibiting effect of platelets and the facilitating effect of GPIIb/IIIa inhibitors in dissolving platelet-rich clots (PRCs). Fluorescent rtPA was used to study the architecture of PRCs, to follow the progression of the rtPA binding front, and to measure the lysis-front velocity using confocal microscopy. Fibrinolysis resistance of PRCs was related to a reduction of both rtPA binding and lysis-front velocities of platelet-rich areas compared with platelet-poor areas (2.4Ϯ0.2 versus 3.5Ϯ0.4 m/min for rtPA binding velocity, Pϭ0.04, and 1.2Ϯ0.6 versus 2.8Ϯ0.2 m/min for lysis-front velocity, Pϭ0.008, in platelet-rich and platelet-poor areas, respectively). Fibrinolysis appeared heterogeneous, leaving platelet-rich areas un-lysed. Adding pharmacological concentrations of abciximab (0.068 mol/L) or eptifibatide (1 mol/L) before clotting decreased the average surface of platelet-rich areas by 64% (Pϭ0.0005) and 72% (Pϭ0.0007), respectively. The resulting equalization of rtPA binding rate and rtPA binding-front velocity between platelet-rich and platelet-poor areas led to a 3-fold increase of the lysis-front velocity in platelet-rich areas of either abciximab-PRC (Pϭ0.006) or eptifibatide-PRC (Pϭ0.03). The overall lysis rate of treated-PRC was increased by 74% compared with control-PRC (PϽ0.01). These results demonstrate that fibrinolysis resistance of PRCs is related primarily to the heterogeneity in the clot structure between platelet-rich and platelet-poor areas. GP IIb/IIIa inhibitors facilitate the rate and the extent of fibrinolysis by improving rtPA binding velocity and, subsequently, the lysis rate in platelet-rich areas. These findings provide new insights on the synergistic potential of GP IIb/IIIa inhibitors and fibrinolytic agents. Key Words: fibrin Ⅲ platelets Ⅲ thrombolysis Ⅲ fibrinolysis Ⅲ inhibitors P latelets play a pivotal role in the fibrinolysis resistance of occluding coronary thrombi, and the benefit of lytic agents in patients with acute myocardial infarction is further improved with concomitant administration of aspirin. 1 More recently, direct inhibition of platelet interactions with fibrin-(ogen) by abciximab (ReoPro) has been shown to restore coronary flow 2 and to improve the outcome of acute myocardial infarction patients undergoing either primary angioplasty or thrombolysis. [3][4][5][6][7][8] In particular, the ability of abciximab alone to restore coronary vessel patency in 17% to 32% of the patients has been related in vitro to its potential to disaggregate preestablished platelet-rich clots (PRCs) and to limit clot extension. 9,10 However, whether these abciximab-mediated structural changes of PRCs can account for the accelerati...