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. 2018 Apr;16(4):652-662.
doi: 10.1111/jth.13957. Epub 2018 Feb 17.

Measuring Fibrinolysis: From Research to Routine Diagnostic Assays

Free PMC article

Measuring Fibrinolysis: From Research to Routine Diagnostic Assays

C Longstaff. J Thromb Haemost. .
Free PMC article


Development and standardization of fibrinolysis methods have progressed more slowly than coagulation testing and routine high-throughput screening tests for fibrinolysis are still lacking. In laboratory research, a variety of approaches are available and are applied to understand the regulation of fibrinolysis and its contribution to the hemostatic balance. Fibrinolysis in normal blood is slow to develop. For practical purposes plasminogen activators can be added to clotting plasma, or euglobulin prepared to reduce endogenous inhibitors, but results are complicated by these manipulations. Observational studies to identify a 'fibrinolysis deficit' have concluded that excess fibrinolysis inhibitors, plasminogen activator inhibitor 1 (PAI-1) or thrombin-activatable fibrinolysis inhibitor (TAFI), zymogen or active enzyme, may be associated with an increased risk of thrombosis. However, results are not always consistent and problems of adequate standardization are evident with these inhibitors and also for measurement of fibrin degradation products (D-dimer). Few methods are available to investigate fibrinolysis under flow, or in whole blood, but viscoelastic methods (VMs) such as ROTEM and TEG do permit the contribution of cells, and importantly platelets, to be explored. VMs are used to diagnose clinical hyperfibrinolysis, which is associated with high mortality. There is a debate on the usefulness of VMs as a point-of-care test method, particularly in trauma. Despite the difficulties of many fibrinolysis methods, research on the fibrinolysis system, taking in wider interactions with hemostasis proteins, is progressing so that in future we may have more complete models and better diagnostic methods and therapeutics.

Keywords: carboxypeptidase B2; euglobulin clot lysis time; fibrin clot lysis time; plasminogen activator inhibitor 1; plasminogen activators; thromboelastometry.


Figure 1
Figure 1
The effect of clot absorbance on lysis rate. In panel A, absorbance values of a clot lysis curve have been scaled to give a hypothetical set of clotting and lysis profiles. The time to clotting and lysis is the same for all curves and the time to 50% clotting and lysis is shown by the magenta and black lines, respectively. The maximum rate of lysis around the 50% lysis point is shown as the dashed line for each curve. Panel B shows the relationship between maximum absorbance and apparent clot lysis rate (open squares), using raw absorbances, or time to 50% lysis from reaction start time (closed circles), or time between 50% clotting and 50% lysis (open circles). The absolute rate of lysis depends on the absorbance range and should not necessarily be interpreted as being influenced by fibrin structure (which also affects absorbance). The time to 50% lysis, however selected, is independent of absolute absorbances. Normalized curves may also be used to avoid this artefact 38. [Color figure can be viewed at]

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