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Semin Thromb Hemost 2023; 49(05): 433-443
DOI: 10.1055/s-0042-1758057
Review Article

Fibrinolysis Shutdown and Hypofibrinolysis Are Not Synonymous Terms: The Clinical Significance of Differentiating Low Fibrinolytic States

Hunter B. Moore
1   Division of Transplant Surgery, Department of Surgery, University of Colorado Denver, Aurora, Colorado
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Funding This research is supported in part by the American Society of Transplant Surgeons Veloxis Fellowship Grant and National Heart Lung and Blood Institute Grant R00-HL151887.
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Abstract

Low fibrinolytic activity has been associated with pathologic thrombosis and multiple-organ failure. Low fibrinolytic activity has two commonly associated terms, hypofibrinolysis and fibrinolysis shutdown. Hypofibrinolysis is a chronic state of lack of ability to generate an appropriate fibrinolytic response when anticipated. Fibrinolysis shutdown is the shutdown of fibrinolysis after systemic activation of the fibrinolytic system. There has been interchanging of these terms to describe critically ill patients in multiple settings. This is problematic in understanding the pathophysiology of disease processes related to these conditions. There is also a lack of research on the cellular mediators of these processes. The purpose of this article is to review the on and off mechanisms of fibrinolysis in the context of low fibrinolytic states to define the importance in differentiating hypofibrinolysis from fibrinolysis shutdown. In many clinical scenarios, the etiology of a low fibrinolytic state cannot be determined due to ambiguity if a preceding fibrinolytic activation event occurred. In this scenario, the term “low fibrinolytic activity” or “fibrinolysis resistance” is a more appropriate descriptor, rather than using assumptive of hypofibrinolysis and fibrinolysis shutdown, particularly in the acute setting of infection, injury, and surgery.

Keywords

fibrinolysis shutdown - hypofibrinolysis - plasminogen activators


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Artikel online veröffentlicht:
01. November 2022

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