However, since tPA can only be given up to 4.5 h post-stroke due to reduced efficacy and increased risk of haemorrhage, only a minority of stroke suffers benefit from tPA treatment.15 Furthermore, clinical evidence suggests that recanalisation of cerebral arteries after tPA therapy is reduced in obese stroke patients, suggesting a reduced efficacy of tPA.16 Similar resistance to thrombolysis has been reported in patients with the metabolic syndrome,17,18 of which obesity is a part. Here, PLAT is linked to obesity due to melanocortin 4 receptor deficiency.