Fibrinolytic parameters in children with noncatheter thrombosis: a pilot study

Abstract

Although the incidence of pediatric thrombosis has increased over the last decade, noncatheter-related deep venous thrombosis (nCDVT) is rare in children. Congenital and acquired hypercoagulable states may play an important role in the pathogenesis of nCDVT. In this study, we evaluated fibrinolytic parameters by measuring individual concentrations of fibrinolytic proteins and by tissue factor initiated whole blood thromboelastography (TEG), in which a fibrin clot was lyzed by exogenously added tissue plasminogen activator (tPA). Children with nCDVT were compared with age and sex-matched controls. TAFI concentrations were significantly higher in the patient group but there was no difference in the PAI-1, tPA and lipoprotein (a) concentrations. Significantly decreased fibrinolysis was found on TEG in the patient group suggesting that hypofibrinolysis may play an important role in the pathogenesis of nCDVT in children. To our knowledge, this is the first pediatric study that has systematically evaluated the role of fibrinolysis in the pathogenesis of DVT. Given our results, the role of fibrinolysis in the pathogenesis of nCDVT in children should be further evaluated in larger studies.

Evaluation of tranexamic acid and ϵ-aminocaproic acid concentrations required to inhibit fibrinolysis in plasma of dogs and humans

“…Previous studies reveal strong associations between TEG measures of fibrinolysis and in vivo serum markers of fibrinolysis. 13,14 In addition, TEG studies in adult and neonatal humans reveal a dose-dependent enhancement of fibrinolysis in vitro with both tPA and urokinase. 13,15 Recently, TEG was used in an in vitro study of hyperfibrinolysis to investigate therapeutic concentrations of EACA in pooled plasma from adult and neonatal humans.…”

Endogenous fibrinolytic potential in tissue‐plasminogen activator‐modified thromboelastography analysis is significantly decreased in dogs suffering from diseases predisposing to thrombosis

“…Specifically, defects of the fibrinolytic system or resistance to fibrinolysis have not been investigated, as no standardized tests are available to measure the global endogenous fibrinolytic potential of whole blood and determined risk factors for thromboembolic disease in dogs. In people, plasminogen‐activator‐induced fibrinolysis has been evaluated by thromboelastography (TEG) in several studies . Fibrinolysis has recently been standardized by using t‐PA‐induced, tissue‐factor (TF)‐activated TEG in human samples, and has been reported to provide rapid assessment of the endogenous fibrinolytic potential of whole blood .…”

Venous Thromboembolism in Children

“…[27][28][29][30][31][32] Unlike adults, the use of clinical probability scores has not been as reliable in identifying children at high risk for developing VTE. Although details of all concomitant injuries were not provided, some of these patients had sustained multisystem trauma.…”