This discrepancy needs to be clarified by further prospective large-scale studies as obese patients might be prone to more in-hospital complications such as venous thromboembolism and the clot-dissolving effect of alteplase may be hampered by plasminogen activator inhibitor-1 which seems to be overexpressed in adipose tissue.[54,55] In general, no obesity paradox was observed for patients treated with IVT. The gene discussed is SERPINE1; the disease is obesity due to melanocortin 4 receptor deficiency.