Knowledge (XXG)

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
148:(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. 214:) 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, 183:. 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. 296:
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.
2154: 155:, 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 738: 620:"Utilization of catheter-directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter-directed thrombolysis" 1130: 97:
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
1984: 1222: 1314: 87:, 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. 164: 2098: 999: 179:. In this assay, increased fibrinolysis is assessed by comparing the TEM profile in the absence or presence of the fibrinolysis inhibitor 731: 1125: 1469: 1047: 1042: 559: 485: 107: 103: 1176: 1265: 261:, and plays a role in disease states associated with inflammation. Plasmin, in addition to lysing fibrin clots, also cleaves the 2140: 2079: 1487: 1460: 1200: 1004: 840: 1414: 780: 2147: 1215: 1080: 724: 30:
from growing and becoming problematic. Primary fibrinolysis is a normal body process, while secondary fibrinolysis is the
110:(PAI-1 and PAI-2). In contrast, plasminogen further stimulates plasmin generation by producing more active forms of both 2213: 1698: 1032: 583:
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
190:(ELT) assay. The ELT measures fibrinolysis by clotting the euglobulin fraction (primarily the fibrinolytic factors 145: 1871: 1845: 1837: 1120: 171:. Alternatively, a more rapid detection of fibrinolytic activity, especially hyperfibrinolysis, is possible with 1208: 286: 2103: 1452: 1376: 946: 942: 2192: 1980: 1061: 805: 774: 278: 187: 168: 125: 23: 2042: 1621: 1576: 1102: 511:"Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients" 156: 1432: 1112: 1089: 1070: 1052: 747: 242:
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).
1941: 1772: 1733: 1703: 1153: 1148: 680: 672: 631: 592: 522: 448: 299: 2187: 1745: 820: 799: 785: 307: 282: 136:(TAFI), which modifies fibrin to make it more resistant to the tPA-mediated plasminogen. 2109: 1636: 1322: 1231: 1158: 685: 660: 277:(the breakdown of a thrombus), fibrinolytic drugs are used. They are given following a 2207: 2066: 2036: 1626: 1611: 1606: 1567: 1239: 971: 895: 850: 453: 436: 330: 76:
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.
661:"Antifibrinolytic Therapy and Perioperative Considerations" 257:
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. 980:Antithrombin (inhibits FII, FIX, FX, FXI, FXII) 16:Process that prevents blood clots from growing 2148: 1216: 732: 8: 134:thrombin-activatable fibrinolysis inhibitor 2155: 2141: 2133: 1674: 1572: 1261: 1223: 1209: 1201: 1085: 760: 739: 725: 717: 175:(TEM) in whole blood, even in patients on 1048:Plasminogen activator inhibitor-2 (PAI-2) 1043:Plasminogen activator inhibitor-1 (PAI-1) 684: 635: 526: 452: 435:Cesarman-Maus G, Hajjar KA (May 2005). 376: 841:High-molecular-weight kininogen (HMWK) 437:"Molecular mechanisms of fibrinolysis" 281:to dissolve the thrombus blocking the 411:"Fibrinolysis - primary or secondary" 246:-antiplasmin have been implicated in 7: 1126:Thrombin–antithrombin complex (TAT) 478:Robbins pathologic basis of disease 384:BSc, Samuel Mckenzie (2019-03-27). 167:and efficacy of treatment in acute 1033:Tissue plasminogen activator (tPA) 990:Protein S (cofactor for protein C) 550:Goodnight SH, Hathaway WE (2001). 250:and various other disease states. 14: 108:plasminogen activator inhibitor-2 104:plasminogen activator inhibitor-1 83:is produced in an inactive form, 1838:Direct thrombin (IIa) inhibitors 1266:Glycoprotein IIb/IIIa inhibitors 454:10.1111/j.1365-2141.2005.05444.x 1461:Thromboxane synthase inhibitors 1121:Prothrombin fragment 1+2 (F1+2) 781:Platelet membrane glycoproteins 985:Protein C (inhibits FV, FVIII) 441:British Journal of Haematology 151:FDPs, and a specific FDP, the 1: 1699:Low-molecular-weight heparin 1510:Phosphodiesterase inhibitors 1423:Acetylsalicylic acid/Aspirin 677:10.1097/ALN.0000000000001997 112:tissue plasminogen activator 91:Tissue plasminogen activator 861:Factor XII (Hageman factor) 775:von Willebrand factor (vWF) 146:fibrin degradation products 45:, is broken down. Its main 2230: 1181:-antiplasmin complex (PAP) 896:Factor III (tissue factor) 624:Catheter Cardiovasc Interv 480:. Philadelphia: Saunders. 306:(ε-aminocaproic acid) and 2173: 2093: 1671:(with some II inhibition) 597:10.1007/s00268-006-0653-9 285:; experimentally after a 1103:β-Thromboglobulin (β-TG) 711:Graphical representation 230:or after severe stress. 1098:Platelet factor 4 (PF4) 995:Protein Z (inhibits FX) 929:Prothrombin (factor II) 386:"What is Fibrinolysis?" 1981:Plasminogen activators 1453:Thromboxane inhibitors 1377:Prostaglandin analogue 1154:Fibrinopeptide B (FpB) 1149:Fibrinopeptide A (FpA) 821:Glycoprotein VI (GPVI) 786:Glycoprotein Ib (GPIb) 254:treated early enough. 77: 2193:Platelet adhesiveness 2043:serine endopeptidases 1577:Vitamin K antagonists 972:Anticoagulant factors 939:Fibrinogen (factor I) 934:Thrombin (factor IIa) 806:Glycoprotein IIb/IIIa 800:Glycoprotein IX (GP9) 767:(platelet activation) 188:euglobulin lysis time 169:myocardial infarction 114:(tPA) and urokinase. 75: 41:clot, the product of 1790:Direct Xa inhibitors 1622:Ethyl biscoumacetate 1488:Receptor antagonists 1159:Fibrin monomers (FM) 1015:Fibrinolytic factors 833:(contact activation) 315:Fibrinolytic enzymes 273:In a process called 157:deep-vein thrombosis 2214:Fibrinolytic system 1433:Carbasalate calcium 1113:Thrombin generation 1090:Platelet activation 1081:Coagulation markers 756:Coagulation factors 748:Coagulation cascade 37:In fibrinolysis, a 2120:Never to phase III 1968:Thrombolytic drugs 1684:glycosaminoglycans 1257:Antiplatelet drugs 1244:antiplatelet drugs 953:Fibrin (factor Ia) 765:Primary hemostasis 528:10.1093/bja/aen083 291:pulmonary embolism 248:metabolic syndrome 173:thromboelastometry 161:pulmonary embolism 78: 32:breakdown of clots 2201: 2200: 2130: 2129: 1962: 1961: 1832: 1831: 1562: 1561: 1198: 1197: 1194: 1193: 1141:Fibrin generation 966: 965: 886:Extrinsic pathway 831:Intrinsic pathway 637:10.1002/ccd.26108 304:aminocaproic acid 300:Antifibrinolytics 263:complement system 2221: 2157: 2150: 2143: 2134: 1942:Drotrecogin alfa 1922:Antithrombin III 1773:Dermatan sulfate 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518: 515:Br J Anaesth 514: 504: 477: 471: 444: 440: 430: 418:. 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Retrieved 390:News-Medical 389: 379: 346:Serrapeptase 341:Lumbrokinase 326:Desmoteplase 321:Anistreplase 298: 295: 279:heart attack 275:thrombolysis 272: 269:Pharmacology 259:inflammation 256: 252: 237: 224:-antiplasmin 208:-antiplasmin 185: 150: 143: 122:-Antiplasmin 116: 89: 79: 36: 20:Fibrinolysis 19: 18: 2178:Coagulation 2164:Coagulation 2106:from market 1927:Defibrotide 1855:Bivalirudin 1824:Rivaroxaban 1763:Heparinoids 1756:Idraparinux 1657:Tioclomarol 1651:Phenindione 1641:Clorindione 1544:Cloricromen 1338:Ticlopidine 1328:Clopidogrel 1023:Plasminogen 958:Factor XIII 876:Factor VIII 415:MedlinePlus 409:Dugdale D. 336:Nattokinase 212:plasminogen 140:Measurement 99:endothelium 93:(t-PA) and 85:plasminogen 43:coagulation 28:blood clots 2167:physiology 2032:Monteplase 1949:Ramatroban 1932:Nafamostat 1917:Abelacimab 1896:Melagatran 1881:Dabigatran 1876:Argatroban 1819:Otamixaban 1804:Betrixaban 1792:("xabans") 1778:Sulodexide 1768:Danaparoid 1739:Tinzaparin 1729:Parnaparin 1724:Nadroparin 1719:Enoxaparin 1714:Dalteparin 1709:Certoparin 1669:inhibitors 1617:Dicoumarol 1518:Cilostazol 1498:Terutroban 1476:Picotamide 1365:Ticagrelor 1349:nucleoside 1345:Nucleotide 1315:inhibitors 1294:Sibrafiban 901:Factor VII 856:Kallikrein 846:Bradykinin 395:2024-05-31 372:References 302:, such as 240:congenital 192:fibrinogen 68:Physiology 56:or by the 2116:Phase III 2104:Withdrawn 2020:Urokinase 2015:Saruplase 1995:Reteplase 1990:Alteplase 1937:Protein C 1891:Inogatran 1886:Efegatran 1872:Univalent 1865:Lepirudin 1860:Desirudin 1809:Darexaban 1734:Reviparin 1704:Bemiparin 1667:Factor Xa 1603:Coumarins 1580:(inhibit 1554:Vorapaxar 1528:Triflusal 1493:Terbogrel 1481:Terbogrel 1470:+ aspirin 1443:Triflusal 1438:Indobufen 1428:Aloxiprin 1390:Beraprost 1360:Elinogrel 1355:Cangrelor 1333:Prasugrel 1299:Tirofiban 1289:Roxifiban 1284:Orbofiban 1274:Abciximab 1177:Plasmin-α 1038:Urokinase 871:Factor IX 866:Factor XI 420:August 7, 361:Bromelain 181:aprotinin 95:urokinase 54:proteases 2208:Category 1846:Bivalent 1814:Edoxaban 1799:Apixaban 1632:Warfarin 1549:Ditazole 1395:Iloprost 1351:analogs 924:Factor V 919:Factor X 695:29200009 646:26308961 605:17426904 570:45485184 537:18440953 496:39465455 463:15842654 366:Honokiol 2085:Oxalate 2075:Citrate 2052:Brinase 1850:Hirudin 1679:Heparin 1655:Other: 1028:Plasmin 686:5811331 177:heparin 153:D-dimer 81:Plasmin 50:plasmin 24:process 2099:WHO-EM 2047:Ancrod 2041:Other 1688:(bind 1681:group/ 815:GPIIIa 693:  683:  644:  603:  568:  558:  535:  494:  484:  461:  351:Papain 287:stroke 210:, and 58:kidney 47:enzyme 39:fibrin 1985:r-tPA 1910:Other 1537:Other 810:GPIIb 795:GP1BB 790:GP1BA 356:DNase 228:DDAVP 216:PAI-1 196:PAI-1 62:liver 22:is a 2080:EDTA 2011:UPA 1954:REG1 1381:PGI2 1242:and 691:PMID 642:PMID 601:PMID 566:OCLC 556:ISBN 533:PMID 492:OCLC 482:ISBN 459:PMID 422:2011 238:Few 124:and 106:and 60:and 1586:VII 1248:B01 1246:) ( 947:FGG 943:FGA 681:PMC 673:doi 669:128 632:doi 593:doi 523:doi 519:100 449:doi 445:129 200:tPA 165:DIC 2210:: 2112:: 2045:: 1983:: 1874:: 1848:: 1639:: 1605:: 1592:, 1590:IX 1588:, 1584:, 1582:II 1311:12 1238:, 945:, 689:. 679:. 667:. 663:. 640:. 628:86 626:. 622:. 599:. 589:31 587:. 564:. 531:. 517:. 513:. 490:. 457:. 443:. 439:. 413:. 388:. 293:. 202:, 198:, 194:, 163:, 159:, 64:. 2156:e 2149:t 2142:v 1970:/ 1692:) 1686:/ 1596:) 1594:X 1472:) 1468:( 1383:) 1379:( 1347:/ 1250:) 1234:( 1224:e 1217:t 1210:v 1179:2 1064:2 1062:α 1055:2 1053:α 949:) 941:( 817:) 808:( 802:) 788:( 783:: 740:e 733:t 726:v 697:. 675:: 648:. 634:: 607:. 595:: 572:. 539:. 525:: 498:. 465:. 451:: 424:. 398:. 244:2 222:2 220:α 206:2 204:α 128:2 126:α 120:2 118:α

Index

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
heparin

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