Fibrinolytic (thrombolytic) agents are used thrombolysis (clot breakdown) in several indications, including acute ST-elevation myocardial infarction, acute pulmonary embolism and acute ischaemic stroke. The pathophysiology of each condition is discussed, as well as indications for the use of fibrinolytic agents. The pathophysiology of thrombosis and the coagulation cascade—which comprises an extrinsic and an intrinsic pathway, leading to a common pathway—are outlined. Commonly used fibrinolytic agents include tenecteplase, reteplase, alteplase, streptokinase and urokinase. Each fibrinolytic agent is reviewed, including indications for use, mode of action, method of administration and dosage, side-effects and contraindications. This enables the reader to be well-informed about fibrinolytic agents and their uses, and provides up-to-date information on their prescription.