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| http://dx.doi.org/10.1016/j.jamcollsurg.2020.08.170 | DOI Listing |
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Fibrinolytic Changes in Critical Illnesses: Is Fibrinolysis Shutdown a Specific Concept?
Juntendo Iji Zasshi
December 2024
Trauma-induced coagulopathy (TIC) is characterized by dynamic changes in fibrinolysis, which can significantly impact patient outcomes. These changes typically manifest in two phases: hyperfibrinolysis followed by fibrinolysis suppression. In the early stages of TIC, there is often an overwhelming release of tissue plasminogen activator, which leads to excessive fibrinolysis.
View Article and Find Full Text PDFHyperfibrinolysis: a crucial phenotypic abnormality of posttraumatic fibrinolytic dysfunction.
Res Pract Thromb Haemost
October 2024
Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA.
Background: Traumatic fibrinolytic dysfunction is often categorized into 3 phenotypes based on the result of thromboelastography (TEG) lysis at 30 minutes (LY30): fibrinolysis shutdown, physiologic fibrinolysis, and hyperfibrinolysis. However, the molecular pathophysiology of fibrinolytic dysfunction and the association with clinical outcomes have not been fully evaluated.
Objectives: To assess whether posttraumatic fibrinolysis phenotypes identified by TEG correlate with levels of key fibrinolysis-related serum markers and with risk of mortality and hospital complications.
A multi-center, double-blind, placebo-controlled, randomized, parallel-group, non-inferiority study to compare the efficacy of goal-directed tranexamic acid administration based on viscoelastic test versus preemptive tranexamic acid administration on postoperative bleeding in cardiovascular surgery (GDT trial).
Trials
September 2024
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Background: Tranexamic acid (TXA) effectively attenuates hyperfibrinolysis and preemptive administration has been employed to reduce bleeding and blood transfusions in various surgical settings. However, TXA administration could be associated with adverse effects, such as seizures and thromboembolic risks. While patients with fibrinolysis shutdown showed greater thromboembolic complications and mortality, TXA administration may aggravate the degree of shutdown in these patients.
View Article and Find Full Text PDFFIBRINOLYTIC DYSFUNCTION AND ENDOTHELIOPATHY AFTER MAJOR THERMAL INJURY: CONSIDERATIONS NEEDED FOR NEW APPROACHES TO BURN SHOCK RESUSCITATION.
Shock
January 2025
Naval Medical Research Unit San Antonio, Joint Base San Antonio-Fort Sam Houston, Texas.
In recent years, it has become apparent that fibrinolytic dysfunction and endotheliopathy develop in up to 40% of patients during the first hours following thermal injury and are associated with poor outcomes and increased resuscitation requirements. Rapidly following burn injury, the fibrinolytic system is activated, with activation generally greater with increased severity of injury. Very high plasma concentrations of plasmin-antiplasmin complex (marker of activation) have been associated with mortality.
View Article and Find Full Text PDFCOVID-19: Not a thrombotic disease but a thromboinflammatory disease.
Ups J Med Sci
February 2024
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
While Coronavirus Disease in 2019 (COVID-19) may no longer be classified as a global public health emergency, it still poses a significant risk at least due to its association with thrombotic events. This study aims to reaffirm our previous hypothesis that COVID-19 is fundamentally a thrombotic disease. To accomplish this, we have undertaken an extensive literature review focused on assessing the comprehensive impact of COVID-19 on the entire hemostatic system.
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