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Preface: Altered Fibrinolysis—Clinical Impact and Diagnostic Challenges
Fibrinolysis is the physiological and continuous process of plasmin-mediated fibrin breakdown, which is regulated to keep the balance between ensuring continued blood supply to end organs and maintaining hemostasis in the face of vascular damage. The importance of a well-regulated fibrinolytic system is illustrated by rare inherited and acquired disorders of fibrinolysis with severe bleeding phenotypes. Moreover, a growing body of evidence demonstrates that altered fibrinolysis plays a pivotal role in the pathophysiology of a range of clinical conditions, and markers of fibrinolysis hold the potential to predict adverse events such as bleeding and thrombosis. Finally, drugs which modulate fibrinolysis have life-saving potential and are used to treat millions of patients each year worldwide, both in the form of profibrinolytics used for thrombolysis, for example, in ischemic stroke and pulmonary emboli, and as antifibrinolytics used to mitigate traumatic, surgical, and postpartum bleeding.
In the current issue of Seminars in Thrombosis and Hemostasis, we have assembled review articles dealing with the fibrinolytic system in pathophysiology, diagnosis, and treatment of clinical disorders, including arterial and venous thrombosis, cancer, sepsis, and liver disease to traumatic brain injury. Furthermore, the use of tranexamic acid in trauma and pediatric surgery is reviewed, and the implication of an emerging treatment, ischemic preconditioning, for fibrinolysis in ischemic stroke is discussed.
30 June 2021 (online)
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- 1 Longstaff C, Kolev K. Basic mechanisms and regulation of fibrinolysis. J Thromb Haemost 2015; 13 (Suppl. 01) S98-S105
- 2 Kolev K, Longstaff C. Bleeding related to disturbed fibrinolysis. Br J Haematol 2016; 175 (01) 12-23
- 3 Lisman T. Decreased plasma fibrinolytic potential as a risk for venous and arterial thrombosis. Semin Thromb Hemost 2017; 43 (02) 178-184
- 4 Undas A. Fibrinolysis in venous thromboembolism. Semin Thromb Hemost 2021; 47 (05) 480-489
- 5 Kietsiriroje N, Ariëns RAS, Ajjan RA. Fibrinolysis in acute and chronic cardiovascular disease. Semin Thromb Hemost 2021; 47 (05) 490-505
- 6 Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA. Antiphospholipid syndrome. Lancet 2010; 376 (9751): 1498-1509
- 7 Antovic A, Bruzelius M. Impaired fibrinolysis in the antiphospholipid syndrome. Semin Thromb Hemost 2021; 47 (05) 506-511
- 8 Colomina MJ, Mendéz E, Sabate A. Altered fibrinolysis during and after surgery. Semin Thromb Hemost 2021; 47 (05) 512-519
- 9 Roberts I, Brenner A, Shakur-Still H. Tranexamic acid treatment for trauma victims. Semin Thromb Hemost 2021; 47 (05) 520-526
- 10 Anderson TN, Rowell SE, Farrell DH. Fibrinolysis in traumatic brain injury: diagnosis, management, and clinical considerations. Semin Thromb Hemost 2021; 47 (05) 527-537
- 11 Hovgesen NT, Larsen JB, Fenger-Eriksen C, Hansen AK, Hvas AM. Efficacy and safety of antifibrinolytic drugs in pediatric surgery: a systematic review. Semin Thromb Hemost 2021; 47 (05) 538-568
- 12 Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5 (03) 632-634
- 13 Weycker D, Hatfield M, Grossman A. et al. Risk and consequences of chemotherapy-induced thrombocytopenia in US clinical practice. BMC Cancer 2019; 19 (01) 151
- 14 Bønløkke ST, Ommen HB, Hvas AM. Altered fibrinolysis in hematological malignances. Semin Thromb Hemost 2021; 47 (05) 569-580
- 15 Winther-Larsen A, Sandfeld-Paulsen B, Hvas AM. Hyperfibrinolysis in patients with solid malignant neoplasms: a systematic review. Semin Thromb Hemost 2021; 47 (05) 581-588
- 16 Larsen JB, Hvas AM. Fibrinolytic alterations in sepsis: biomarkers and future treatment targets. Semin Thromb Hemost 2021; 47 (05) 589-600
- 17 Von Meijenfeldt FA, Lisman T. Fibrinolysis in patients with liver disease. Semin Thromb Hemost 2021; 47 (05) 601-609
- 18 Krag AE, Blauenfeldt RA. Fibrinolysis and remote ischemic conditioning: mechanisms and treatment perspectives in stroke. Semin Thromb Hemost 2021; 47 (05) 610-620