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Fibrinolysis

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are used as inhibitors of fibrinolysis. Their application may be beneficial in patients with hyperfibrinolysis because they arrest bleeding rapidly if the other components of the haemostatic system are not severely affected. This may help to avoid the use of blood products such as fresh frozen plasma
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However, acquired disturbance of fibrinolysis (hyperfibrinolysis), is not uncommon. Many trauma patients have an overwhelming activation of tissue factor and thus massive hyperfibrinolysis. Hyperfibrinolysis may occur in other disease states. It could lead to massive bleeding if not diagnosed and
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of the blood vessels, such that, after several days (when the bleeding has stopped), the clot is broken down. This occurs because plasminogen became entrapped within the clot when it formed; as it is slowly activated, it breaks down the fibrin mesh. t-PA and urokinase are themselves inhibited by
159:(FDPs). FDPs compete with thrombin, and thus slow down clot formation by preventing the conversion of fibrinogen to fibrin. This effect can be seen in the thrombin clotting time (TCT) test, which is prolonged in a person that has active fibrinolysis. 225:) from plasma and then observing the time required for clot dissolution. A shortened lysis time indicates a hyperfibrinolytic state and bleeding risk. Such results can be seen in peoples with liver disease, 194:. Clinically, the TEM is useful for near real-time measurement of activated fibrinolysis for at-risk patients, such as those experiencing significant blood loss during surgery. 307:
Thrombolysis refers to the dissolution of the thrombus due to various agents while fibrinolysis refers specifically to the agents causing fibrin breakdown in the clot.
2165: 166:, can be measured using antibody-antigen technology. This is more specific than the TCT, and confirms that fibrinolysis has occurred. It is therefore used to indicate 749: 631:"Utilization of catheter-directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter-directed thrombolysis" 1141: 108:
are the agents that convert plasminogen to the active plasmin, thus allowing fibrinolysis to occur. t-PA is released into the blood slowly by the damaged
1995: 1233: 1325: 98:, in the liver. Although plasminogen cannot cleave fibrin, it still has an affinity for it, and is incorporated into the clot when it is formed. 175: 2109: 1010: 190:. In this assay, increased fibrinolysis is assessed by comparing the TEM profile in the absence or presence of the fibrinolysis inhibitor 742: 1136: 1480: 1058: 1053: 570: 496: 118: 114: 1187: 1276: 272:, and plays a role in disease states associated with inflammation. Plasmin, in addition to lysing fibrin clots, also cleaves the 2151: 2090: 1498: 1471: 1211: 1015: 851: 1425: 791: 2158: 1226: 1091: 735: 41:
from growing and becoming problematic. Primary fibrinolysis is a normal body process, while secondary fibrinolysis is the
121:(PAI-1 and PAI-2). In contrast, plasminogen further stimulates plasmin generation by producing more active forms of both 2224: 1709: 1043: 594:
Tieu BH, Holcomb JB, Schreiber MA (May 2007). "Coagulopathy: its pathophysiology and treatment in the injured patient".
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cuts the fibrin mesh at various places, leading to the production of circulating fragments that are cleared by other
201:(ELT) assay. The ELT measures fibrinolysis by clotting the euglobulin fraction (primarily the fibrinolytic factors 156: 1882: 1856: 1848: 1131: 182:. Alternatively, a more rapid detection of fibrinolytic activity, especially hyperfibrinolysis, is possible with 1219: 297: 2114: 1463: 1387: 957: 953: 2203: 1991: 1072: 816: 785: 289: 198: 179: 136: 34: 2053: 1632: 1587: 1113: 522:"Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients" 167: 1443: 1123: 1100: 1081: 1063: 758: 253:
disorders of the fibrinolytic system have been documented. Nevertheless, excess levels of PAI and α
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component C3, and fibrin degradation products have some vascular permeability inducing effects.
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Patel N, Patel NJ, Agnihotri K, Panaich SS, Thakkar B, Patel A, et al. (December 2015).
1952: 1783: 1744: 1714: 1164: 1159: 691: 683: 642: 603: 533: 459: 310: 2198: 1756: 831: 810: 796: 318: 293: 147:(TAFI), which modifies fibrin to make it more resistant to the tPA-mediated plasminogen. 2120: 1647: 1333: 1242: 1169: 696: 671: 288:(the breakdown of a thrombus), fibrinolytic drugs are used. They are given following a 2218: 2077: 2047: 1637: 1622: 1617: 1578: 1250: 982: 906: 861: 464: 447: 341: 87:
Fibrinolysis (simplified). Blue arrows denote stimulation, and red arrows inhibition.
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Levrat A, Gros A, Rugeri L, Inaba K, Floccard B, Negrier C, David JS (June 2008).
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to allow blood flow back to the affected part of the brain; and in the event of
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with its associated risks of infections or anaphylactic reactions.
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deficiency. Similar results are also seen after administration of
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Levy JH, Koster A, Quinones QJ, Milling TJ, Key NS (March 2018).
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Disorders of hemostasis and thrombosis : a clinical guide
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Protein Z-related protease inhibitor (ZPI) (inhibits FX, FXI)
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due to a medicine, a medical disorder, or some other cause.
672:"Antifibrinolytic Therapy and Perioperative Considerations" 268:
The fibrinolytic system is closely linked to control of
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inactivate plasmin. Plasmin activity is also reduced by
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Tissue factor pathway inhibitor (TFPI) (inhibits FIII)
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Testing of overall fibrinolysis can be measured by a
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Plasmin breaks down fibrin into soluble parts called
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Division. 991:Antithrombin (inhibits FII, FIX, FX, FXI, FXII) 27:Process that prevents blood clots from growing 2159: 1227: 743: 8: 145:thrombin-activatable fibrinolysis inhibitor 2166: 2152: 2144: 1685: 1583: 1272: 1234: 1220: 1212: 1096: 771: 750: 736: 728: 186:(TEM) in whole blood, even in patients on 1059:Plasminogen activator inhibitor-2 (PAI-2) 1054:Plasminogen activator inhibitor-1 (PAI-1) 695: 646: 537: 463: 446:Cesarman-Maus G, Hajjar KA (May 2005). 387: 852:High-molecular-weight kininogen (HMWK) 448:"Molecular mechanisms of fibrinolysis" 292:to dissolve the thrombus blocking the 422:"Fibrinolysis - primary or secondary" 257:-antiplasmin have been implicated in 7: 1137:Thrombin–antithrombin complex (TAT) 489:Robbins pathologic basis of disease 395:BSc, Samuel Mckenzie (2019-03-27). 178:and efficacy of treatment in acute 1044:Tissue plasminogen activator (tPA) 1001:Protein S (cofactor for protein C) 561:Goodnight SH, Hathaway WE (2001). 261:and various other disease states. 25: 119:plasminogen activator inhibitor-2 115:plasminogen activator inhibitor-1 94:is produced in an inactive form, 1849:Direct thrombin (IIa) inhibitors 1277:Glycoprotein IIb/IIIa inhibitors 465:10.1111/j.1365-2141.2005.05444.x 1472:Thromboxane synthase inhibitors 1132:Prothrombin fragment 1+2 (F1+2) 792:Platelet membrane glycoproteins 996:Protein C (inhibits FV, FVIII) 452:British Journal of Haematology 162:FDPs, and a specific FDP, the 1: 1710:Low-molecular-weight heparin 1521:Phosphodiesterase inhibitors 1434:Acetylsalicylic acid/Aspirin 688:10.1097/ALN.0000000000001997 123:tissue plasminogen activator 102:Tissue plasminogen activator 872:Factor XII (Hageman factor) 786:von Willebrand factor (vWF) 157:fibrin degradation products 56:, is broken down. Its main 2241: 1192:-antiplasmin complex (PAP) 907:Factor III (tissue factor) 635:Catheter Cardiovasc Interv 491:. Philadelphia: Saunders. 317:(ε-aminocaproic acid) and 2184: 2104: 1682:(with some II inhibition) 608:10.1007/s00268-006-0653-9 296:; experimentally after a 1114:β-Thromboglobulin (β-TG) 722:Graphical representation 241:or after severe stress. 1109:Platelet factor 4 (PF4) 1006:Protein Z (inhibits FX) 940:Prothrombin (factor II) 397:"What is Fibrinolysis?" 1992:Plasminogen activators 1464:Thromboxane inhibitors 1388:Prostaglandin analogue 1165:Fibrinopeptide B (FpB) 1160:Fibrinopeptide A (FpA) 832:Glycoprotein VI (GPVI) 797:Glycoprotein Ib (GPIb) 265:treated early enough. 88: 2204:Platelet adhesiveness 2054:serine endopeptidases 1588:Vitamin K antagonists 983:Anticoagulant factors 950:Fibrinogen (factor I) 945:Thrombin (factor IIa) 817:Glycoprotein IIb/IIIa 811:Glycoprotein IX (GP9) 778:(platelet activation) 199:euglobulin lysis time 180:myocardial infarction 125:(tPA) and urokinase. 86: 52:clot, the product of 1801:Direct Xa inhibitors 1633:Ethyl biscoumacetate 1499:Receptor antagonists 1170:Fibrin monomers (FM) 1026:Fibrinolytic factors 844:(contact activation) 326:Fibrinolytic enzymes 284:In a process called 168:deep-vein thrombosis 2225:Fibrinolytic system 1444:Carbasalate calcium 1124:Thrombin generation 1101:Platelet activation 1092:Coagulation markers 767:Coagulation factors 759:Coagulation cascade 48:In fibrinolysis, a 2131:Never to phase III 1979:Thrombolytic drugs 1695:glycosaminoglycans 1268:Antiplatelet drugs 1255:antiplatelet drugs 964:Fibrin (factor Ia) 776:Primary hemostasis 539:10.1093/bja/aen083 302:pulmonary embolism 259:metabolic syndrome 184:thromboelastometry 172:pulmonary embolism 89: 43:breakdown of clots 2212: 2211: 2141: 2140: 1973: 1972: 1843: 1842: 1573: 1572: 1209: 1208: 1205: 1204: 1152:Fibrin generation 977: 976: 897:Extrinsic pathway 842:Intrinsic pathway 648:10.1002/ccd.26108 315:aminocaproic acid 311:Antifibrinolytics 274:complement system 16:(Redirected from 2232: 2168: 2161: 2154: 2145: 1953:Drotrecogin alfa 1933:Antithrombin III 1784:Dermatan sulfate 1757:Oligosaccharides 1686: 1584: 1320:ADP receptor/P2Y 1273: 1236: 1229: 1222: 1213: 1097: 772: 752: 745: 738: 729: 710: 709: 699: 667: 661: 660: 650: 626: 620: 619: 591: 585: 584: 558: 552: 551: 541: 517: 511: 510: 484: 478: 477: 467: 443: 437: 436: 434: 432: 417: 411: 410: 408: 407: 392: 21: 2240: 2239: 2235: 2234: 2233: 2231: 2230: 2229: 2215: 2214: 2213: 2208: 2199:Clot retraction 2180: 2172: 2142: 2137: 2136: 2121:Clinical trials 2100: 2072: 1982: 1969: 1916: 1839: 1795: 1698: 1693: 1681: 1672: 1648:1,3-Indandiones 1590: 1569: 1543: 1515: 1458: 1420: 1382: 1334:Thienopyridines 1323: 1314: 1262: 1243:Antithrombotics 1240: 1210: 1201: 1191: 1174: 1146: 1118: 1086: 1076: 1067: 1020: 973: 916: 899:(tissue factor) 898: 891: 843: 836: 777: 761: 756: 718: 713: 669: 668: 664: 628: 627: 623: 593: 592: 588: 573: 560: 559: 555: 519: 518: 514: 499: 486: 485: 481: 445: 444: 440: 430: 428: 419: 418: 414: 405: 403: 394: 393: 389: 385: 328: 319:tranexamic acid 294:coronary artery 282: 256: 247: 245:Role in disease 234: 218: 153: 140: 132: 81: 28: 23: 22: 15: 12: 11: 5: 2238: 2236: 2228: 2227: 2217: 2216: 2210: 2209: 2207: 2206: 2201: 2196: 2191: 2185: 2182: 2181: 2173: 2171: 2170: 2163: 2156: 2148: 2139: 2138: 2135: 2134: 2133: 2132: 2129: 2118: 2112: 2106: 2105: 2102: 2101: 2099: 2098: 2093: 2088: 2082: 2080: 2074: 2073: 2071: 2070: 2065: 2060: 2050: 2045: 2040: 2035: 2034: 2033: 2028: 2020: 2019: 2018: 2013: 2008: 2003: 1988: 1986: 1975: 1974: 1971: 1970: 1968: 1967: 1962: 1957: 1956: 1955: 1945: 1940: 1935: 1930: 1924: 1922: 1918: 1917: 1915: 1914: 1909: 1904: 1899: 1894: 1889: 1880: 1879: 1878: 1873: 1868: 1853: 1851: 1845: 1844: 1841: 1840: 1838: 1837: 1832: 1827: 1822: 1817: 1812: 1806: 1804: 1797: 1796: 1794: 1793: 1792: 1791: 1786: 1781: 1771: 1770: 1769: 1764: 1754: 1753: 1752: 1747: 1742: 1737: 1732: 1727: 1722: 1717: 1706: 1704: 1683: 1674: 1673: 1671: 1670: 1664: 1659: 1654: 1645: 1640: 1635: 1630: 1625: 1620: 1610: 1608: 1581: 1579:Anticoagulants 1575: 1574: 1571: 1570: 1568: 1567: 1562: 1557: 1551: 1549: 1545: 1544: 1542: 1541: 1536: 1531: 1525: 1523: 1517: 1516: 1514: 1513: 1512: 1511: 1506: 1496: 1495: 1494: 1489: 1484: 1468: 1466: 1460: 1459: 1457: 1456: 1451: 1446: 1441: 1436: 1430: 1428: 1426:COX inhibitors 1422: 1421: 1419: 1418: 1413: 1408: 1403: 1397: 1395: 1384: 1383: 1381: 1380: 1379: 1378: 1373: 1368: 1353: 1352: 1351: 1346: 1341: 1330: 1328: 1321: 1316: 1315: 1313: 1312: 1307: 1302: 1297: 1292: 1287: 1281: 1279: 1270: 1264: 1263: 1251:anticoagulants 1241: 1239: 1238: 1231: 1224: 1216: 1207: 1206: 1203: 1202: 1200: 1199: 1194: 1189: 1184: 1182: 1176: 1175: 1173: 1172: 1167: 1162: 1156: 1154: 1148: 1147: 1145: 1144: 1139: 1134: 1128: 1126: 1120: 1119: 1117: 1116: 1111: 1105: 1103: 1094: 1088: 1087: 1085: 1084: 1079: 1077:-Macroglobulin 1074: 1070: 1065: 1061: 1056: 1051: 1046: 1041: 1036: 1030: 1028: 1022: 1021: 1019: 1018: 1013: 1008: 1003: 998: 993: 987: 985: 979: 978: 975: 974: 972: 971: 966: 961: 947: 942: 937: 932: 926: 924: 922:Common pathway 918: 917: 915: 914: 909: 903: 901: 893: 892: 890: 889: 884: 879: 874: 869: 864: 859: 854: 848: 846: 838: 837: 835: 834: 829: 823: 814: 808: 803: 788: 782: 780: 769: 763: 762: 757: 755: 754: 747: 740: 732: 726: 725: 717: 716:External links 714: 712: 711: 682:(3): 657–670. 676:Anesthesiology 662: 641:(7): 1219–27. 621: 602:(5): 1055–64. 586: 571: 553: 512: 497: 479: 438: 412: 386: 384: 381: 380: 379: 374: 369: 364: 359: 354: 349: 344: 339: 334: 327: 324: 281: 278: 254: 246: 243: 232: 229:deficiency or 216: 152: 149: 141:-macroglobulin 138: 130: 80: 77: 37:that prevents 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 2237: 2226: 2223: 2222: 2220: 2205: 2202: 2200: 2197: 2195: 2192: 2190: 2187: 2186: 2183: 2179: 2176: 2169: 2164: 2162: 2157: 2155: 2150: 2149: 2146: 2130: 2128: 2125: 2124: 2122: 2119: 2116: 2113: 2111: 2108: 2107: 2103: 2097: 2094: 2092: 2089: 2087: 2084: 2083: 2081: 2079: 2078:Non-medicinal 2075: 2069: 2066: 2064: 2061: 2059: 2055: 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531: 527: 523: 516: 513: 508: 504: 500: 498:0-7216-7335-X 494: 490: 483: 480: 475: 471: 466: 461: 458:(3): 307–21. 457: 453: 449: 442: 439: 427: 423: 416: 413: 402: 398: 391: 388: 382: 378: 375: 373: 370: 368: 365: 363: 360: 358: 355: 353: 350: 348: 345: 343: 342:Streptokinase 340: 338: 335: 333: 330: 329: 325: 323: 320: 316: 312: 308: 305: 303: 299: 295: 291: 287: 279: 277: 275: 271: 266: 262: 260: 252: 244: 242: 240: 236: 228: 224: 220: 212: 208: 204: 200: 195: 193: 189: 185: 181: 177: 173: 169: 165: 160: 158: 150: 148: 146: 142: 134: 126: 124: 120: 116: 111: 107: 103: 99: 97: 93: 85: 78: 76: 74: 70: 66: 62: 59: 55: 51: 46: 44: 40: 36: 32: 19: 2194:Fibrinolysis 2193: 2068:Fibrinolysin 2038:Anistreplase 2016:Desmoteplase 2011:Tenecteplase 1912:Ximelagatran 1762:Fondaparinux 1701:antithrombin 1657:Diphenadione 1534:Dipyridamole 1477:Dipyridamole 1416:Treprostinil 1411:Prostacyclin 1290:Eptifibatide 1197:D-Dimer (DD) 1180:Fibrinolysis 1179: 1068:-Antiplasmin 1025: 790: 679: 675: 665: 638: 634: 624: 599: 596:World J Surg 595: 589: 562: 556: 532:(6): 792–7. 529: 526:Br J Anaesth 525: 515: 488: 482: 455: 451: 441: 429:. 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Retrieved 401:News-Medical 400: 390: 357:Serrapeptase 352:Lumbrokinase 337:Desmoteplase 332:Anistreplase 309: 306: 290:heart attack 286:thrombolysis 283: 280:Pharmacology 270:inflammation 267: 263: 248: 235:-antiplasmin 219:-antiplasmin 196: 161: 154: 133:-Antiplasmin 127: 100: 90: 47: 31:Fibrinolysis 30: 29: 18:Fibrinolytic 2189:Coagulation 2175:Coagulation 2117:from market 1938:Defibrotide 1866:Bivalirudin 1835:Rivaroxaban 1774:Heparinoids 1767:Idraparinux 1668:Tioclomarol 1662:Phenindione 1652:Clorindione 1555:Cloricromen 1349:Ticlopidine 1339:Clopidogrel 1034:Plasminogen 969:Factor XIII 887:Factor VIII 426:MedlinePlus 420:Dugdale D. 347:Nattokinase 223:plasminogen 151:Measurement 110:endothelium 104:(t-PA) and 96:plasminogen 54:coagulation 39:blood clots 2178:physiology 2043:Monteplase 1960:Ramatroban 1943:Nafamostat 1928:Abelacimab 1907:Melagatran 1892:Dabigatran 1887:Argatroban 1830:Otamixaban 1815:Betrixaban 1803:("xabans") 1789:Sulodexide 1779:Danaparoid 1750:Tinzaparin 1740:Parnaparin 1735:Nadroparin 1730:Enoxaparin 1725:Dalteparin 1720:Certoparin 1680:inhibitors 1628:Dicoumarol 1529:Cilostazol 1509:Terutroban 1487:Picotamide 1376:Ticagrelor 1360:nucleoside 1356:Nucleotide 1326:inhibitors 1305:Sibrafiban 912:Factor VII 867:Kallikrein 857:Bradykinin 406:2024-05-31 383:References 313:, such as 251:congenital 203:fibrinogen 79:Physiology 67:or by the 2127:Phase III 2115:Withdrawn 2031:Urokinase 2026:Saruplase 2006:Reteplase 2001:Alteplase 1948:Protein C 1902:Inogatran 1897:Efegatran 1883:Univalent 1876:Lepirudin 1871:Desirudin 1820:Darexaban 1745:Reviparin 1715:Bemiparin 1678:Factor Xa 1614:Coumarins 1591:(inhibit 1565:Vorapaxar 1539:Triflusal 1504:Terbogrel 1492:Terbogrel 1481:+ aspirin 1454:Triflusal 1449:Indobufen 1439:Aloxiprin 1401:Beraprost 1371:Elinogrel 1366:Cangrelor 1344:Prasugrel 1310:Tirofiban 1300:Roxifiban 1295:Orbofiban 1285:Abciximab 1188:Plasmin-α 1049:Urokinase 882:Factor IX 877:Factor XI 431:August 7, 372:Bromelain 192:aprotinin 106:urokinase 65:proteases 2219:Category 1857:Bivalent 1825:Edoxaban 1810:Apixaban 1643:Warfarin 1560:Ditazole 1406:Iloprost 1362:analogs 935:Factor V 930:Factor X 706:29200009 657:26308961 616:17426904 581:45485184 548:18440953 507:39465455 474:15842654 377:Honokiol 2096:Oxalate 2086:Citrate 2063:Brinase 1861:Hirudin 1690:Heparin 1666:Other: 1039:Plasmin 697:5811331 188:heparin 164:D-dimer 92:Plasmin 61:plasmin 35:process 2110:WHO-EM 2058:Ancrod 2052:Other 1699:(bind 1692:group/ 826:GPIIIa 704:  694:  655:  614:  579:  569:  546:  505:  495:  472:  362:Papain 298:stroke 221:, and 69:kidney 58:enzyme 50:fibrin 1996:r-tPA 1921:Other 1548:Other 821:GPIIb 806:GP1BB 801:GP1BA 367:DNase 239:DDAVP 227:PAI-1 207:PAI-1 73:liver 33:is a 2091:EDTA 2022:UPA 1965:REG1 1392:PGI2 1253:and 702:PMID 653:PMID 612:PMID 577:OCLC 567:ISBN 544:PMID 503:OCLC 493:ISBN 470:PMID 433:2011 249:Few 135:and 117:and 71:and 1597:VII 1259:B01 1257:) ( 958:FGG 954:FGA 692:PMC 684:doi 680:128 643:doi 604:doi 534:doi 530:100 460:doi 456:129 211:tPA 176:DIC 2221:: 2123:: 2056:: 1994:: 1885:: 1859:: 1650:: 1616:: 1603:, 1601:IX 1599:, 1595:, 1593:II 1322:12 1249:, 956:, 700:. 690:. 678:. 674:. 651:. 639:86 637:. 633:. 610:. 600:31 598:. 575:. 542:. 528:. 524:. 501:. 468:. 454:. 450:. 424:. 399:. 304:. 213:, 209:, 205:, 174:, 170:, 75:. 2167:e 2160:t 2153:v 1981:/ 1703:) 1697:/ 1607:) 1605:X 1483:) 1479:( 1394:) 1390:( 1358:/ 1261:) 1245:( 1235:e 1228:t 1221:v 1190:2 1075:2 1073:α 1066:2 1064:α 960:) 952:( 828:) 819:( 813:) 799:( 794:: 751:e 744:t 737:v 708:. 686:: 659:. 645:: 618:. 606:: 583:. 550:. 536:: 509:. 476:. 462:: 435:. 409:. 255:2 233:2 231:α 217:2 215:α 139:2 137:α 131:2 129:α 20:)

Index

Fibrinolytic
process
blood clots
breakdown of clots
fibrin
coagulation
enzyme
plasmin
proteases
kidney
liver

Plasmin
plasminogen
Tissue plasminogen activator
urokinase
endothelium
plasminogen activator inhibitor-1
plasminogen activator inhibitor-2
tissue plasminogen activator
α2-Antiplasmin
α2-macroglobulin
thrombin-activatable fibrinolysis inhibitor
fibrin degradation products
D-dimer
deep-vein thrombosis
pulmonary embolism
DIC
myocardial infarction
thromboelastometry

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