Elucidating the molecular mechanisms of fibrinolytic shutdown after severe injury: The role of thrombin-activatable fibrinolysis inhibitor

Abstract

Fibrinolytic shutdown (versus hypofibrinolysis) = plasmin burst followed by diminished fibrinolysis. After thrombin and plasmin burst, fibrinolysis is inhibited, mediated by increased TAFI. #TAFI #TIC #surgscience @JuliaColemanMD @CUDeptSurg @DenverHealthMed @mitchelljayc

Losing the forest for the trees: the complexities of fibrinolysis will never be explained with one variable alone

“…1 Among our 56 patients, cluster analysis revealed that patients with diminished fibrinolysis had significantly higher PAP and TAFI, suggesting that fibrinolytic shutdown is indeed characterized by an initial plasmin burst (increased PAP) followed by diminished fibrinolysis (mediated in part by TAFI). 1 We appreciate Dr. Zhu echoing the literature that has also suggested linkage between TAFI and fibrinolytic shutdown. 2 While the findings from our study are consistent, this is by no means an assertion that TAFI is the sole driver of fibrinolytic shutdown.…”

“…To the Editor: W e read with interest the article by Kluck et al, 1 and we thank the authors for sharing their extensive experience with resuscitative endovascular balloon occlusion of the aorta (REBOA) during placenta accreta spectrum (PAS) surgery and highlighting important anatomical considerations.…”

“…W e read with great interest the article by Coleman et al 1 concerning the major role of thrombin activatable fibrinolysis inhibitor (TAFI) in fibrinolytic shutdown (SD) after injury. In this observational cohort study, the authors found that Group 2 (fibrinolysis SD, n = 35) had significantly higher plasmin-antiplasmin (median, 4.7 [interquartile range (IQR), 1.7-9.3] vs. 1.4 [1.0-2.1] μg/mL in Group 1; p = 0.002) and higher TAFI (median, 152.5% [IQR,.7%] vs. 121.9% [IQR, 93.2-155.6%] in Group 1, p = 0.04) compared with Group 1 (normal fibrinolysis, n = 21).…”

Facing complex coagulation world, we should avoid a peep through a tube at a leopard

“…1 Among our 56 patients, cluster analysis revealed that patients with diminished fibrinolysis had significantly higher PAP and TAFI, suggesting that fibrinolytic shutdown is indeed characterized by an initial plasmin burst (increased PAP) followed by diminished fibrinolysis (mediated in part by TAFI). 1 We appreciate Dr. Zhu echoing the literature that has also suggested linkage between TAFI and fibrinolytic shutdown. 2…”

“…We read with great interest the article by Coleman et al 1 concerning the major role of thrombin activatable fibrinolysis inhibitor (TAFI) in fibrinolytic shutdown (SD) after injury. In this observational cohort study, the authors found that Group 2 (fibrinolysis SD, n = 35) had significantly higher plasmin-antiplasmin (median, 4.7 [interquartile range (IQR), 1.7–9.3] vs. 1.4 [1.0–2.1] μg/mL in Group 1; p = 0.002) and higher TAFI (median, 152.5% [IQR, 110.3–190.7%] vs. 121.9% [IQR, 93.2–155.6%] in Group 1, p = 0.04) compared with Group 1 (normal fibrinolysis, n = 21).…”