Management of acute myocardial infarction (AMI) has undergone seismic changes in the last two decades, primarily with the global availability of thrombolytic agents and with the burgeoning use of Primary PCI. Application of these two modalities has dramatically reduced both the mortality and morbidity from AMI. Advances in thrombolytic therapy have been noteworthy in three areas: firstly, in genetically engineering superior third-generation lytic agents: secondly, in developing protocols of appropriate use, and thirdly, creating unambiguous guidelines for admninistration of thrombolytics, of utilizing Primary PCI, or hybrid strategies. Our submitted review on thrombolytic therapy builds on this scientific progress. It provides a pertinent historical perspective that elucidates discovery of lytic agents and the vast array of biogenetic inventions that lead to the development of the novel agent, tenecteplase. The review manuscript also provides a comprehensive compendium of the numerous clinical trials that have been methodically presented in easy-to-read tables. We have additionally designed these tables to facilitate comparison of different lytic agents and for critical analysis of the individual clinical trials. Finally, to make this review most relevant for the IHJ, a section has been devoted to the use of thrombolytic therapy in India. Unique attributes of tenecteplase have been discussed and the benefits of using it to treat Indian patients have been highlighted.