Sol Sherry. 318 pages. Philadelphia: Lea & Febiger; 1992. $59.50.

Any book dedicated to more than 100 of the author's colleagues and collaborators is likely to be rich in historical perspective. In this book, written by one of the pioneers in thrombolytic therapy, we cover almost 60 years of scientific inquiry in fibrinolysis: from Tillett's observations on filtrates of streptococci in 1933 to recombinant activators and adjuvant agents in the 1990s. There is a brief discussion of streptokinase administration into the intrapleural space for treatment of hemothorax and empyema, and of the trials for acute myocardial infarction that started in 1958. Another interesting vignette is the early purification of urokinase, a process requiring 300 gallons for enough material to treat a single patient!

Despite its strong historical perspective, this book is as contemporary as any available in this field. The chapters on using thrombolytic therapy for myocardial infarction, pulmonary embolism, deep venous thrombosis, peripheral artery embolism, and stroke present up-to-date overviews of the literature for these indications. The discussion of the thrombolytic agents, including mechanism of action, comparative pharmacology, and adverse reactions is succinct but thorough. The discussions of bleeding complications, rethrombosis, and laboratory monitoring are valuable. There are also excellent chapters on basic concepts of thrombosis and hemostasis, with thrombolysis discussed as a dynamic process of competition between thrombus propagation and fibrinolysis.

The chapter on "basic concepts of fibrinolysis" might better have been divided into "historical concepts" and "current concepts." As written, the latter topic is somewhat abbreviated. The "notes" placed at the end of each chapter might preferably have been incorporated into the text or eliminated. The last chapter on antifibrinolytic agents does not discuss their use to reverse thrombolytic bleeding, an important omission because so much of the book concerns thrombolytic therapy. Despite these and other minor flaws, this is an excellent book. Every student of fibrinolysis, from the clinical investigator planning thrombolytic therapy trials to the basic scientist, can learn much in these pages.