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
