Semin Thromb Hemost 2021; 47(05): 490-505
DOI: 10.1055/s-0040-1718923
Review Article

Fibrinolysis in Acute and Chronic Cardiovascular Disease

Noppadol Kietsiriroje
1  Department of Metabolic Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
2  Endocrinology and Metabolism Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
,
Robert A.S. Ariëns
1  Department of Metabolic Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
,
1  Department of Metabolic Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
› Author Affiliations
Funding This work received no specific funding. N.K. was funded by the Faculty of Medicine, Prince of Songkla University, Thailand. R.A.A.'s research work was supported by grants from the NIHR, Diabetes UK, the British Heart Foundation, Avacta Life Sciences, and Abbott Diabetes Care. R.A.S.A. was supported by the British Heart Foundation (RG/18/11/34036) and the Wellcome Trust (204951/B/16/Z).

Abstract

The formation of an obstructive thrombus within an artery remains a major cause of mortality and morbidity worldwide. Despite effective inhibition of platelet function by modern antiplatelet therapies, these agents fail to fully eliminate atherothrombotic risk. This may well be related to extensive vascular disease, beyond the protective abilities of the treatment agents used. However, recent evidence suggests that residual vascular risk in those treated with modern antiplatelet therapies is related, at least in part, to impaired fibrin clot lysis. In this review, we attempt to shed more light on the role of hypofibrinolysis in predisposition to arterial vascular events. We provide a brief overview of the coagulation system followed by addressing the role of impaired fibrin clot lysis in acute and chronic vascular conditions, including coronary artery, cerebrovascular, and peripheral vascular disease. We also discuss the role of combined anticoagulant and antiplatelet therapies to reduce the risk of arterial thrombotic events, addressing both efficacy and safety of such an approach. We conclude that impaired fibrin clot lysis appears to contribute to residual thrombosis risk in individuals with arterial disease on antiplatelet therapy, and targeting proteins in the fibrinolytic system represents a viable strategy to improve outcome in this population. Future work is required to refine the antithrombotic approach by modulating pathological abnormalities in the fibrinolytic system and tailoring therapy according to the need of each individual.

Authors' Contributions

N.K. was responsible for drafting and writing of the manuscript, searching of literature, and interpreting of data. R.A.S.A. and R.A.A. were responsible for the drafting and writing of the manuscript and critical revision of important intellectual content. All authors approved the version to be published.




Publication History

Publication Date:
20 April 2021 (online)

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