Fibrinolysis and bleeding of unknown cause
Abstract Patients with bleeding of unknown cause (BUC) present with a variety of mild to moderate bleeding symptoms, but no hemostatic abnormalities can be found. Hyperfibrinolysis is rarely evaluated as the underlying cause for bleeding in clinical practice, and well‐established global assays for a...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-05-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rth2.12511 |
| _version_ | 1797727193137152000 |
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| author | Dino Mehic Ingrid Pabinger Cihan Ay Johanna Gebhart |
| author_facet | Dino Mehic Ingrid Pabinger Cihan Ay Johanna Gebhart |
| author_sort | Dino Mehic |
| collection | DOAJ |
| description | Abstract Patients with bleeding of unknown cause (BUC) present with a variety of mild to moderate bleeding symptoms, but no hemostatic abnormalities can be found. Hyperfibrinolysis is rarely evaluated as the underlying cause for bleeding in clinical practice, and well‐established global assays for abnormal fibrinolysis are lacking. Few patients with definitive fibrinolytic disorders, including α2‐antiplasmin deficiency, plasminogen activator inhibitor 1 deficiency, or Quebec platelet disorder, have been reported. This review aims to summarize data on established fibrinolytic disorders and to discuss assessments of fibrinolysis in prior bleeding cohorts. Furthermore, we review available global tests with the potential to measure fibrinolysis, such as turbidity fibrin clot assays and rotational thromboelastometry, and their relevance in the workup of patients with BUC. We conclude that, due to the lack of adequate global tests, hyperfibrinolysis might be an underdiagnosed cause for a bleeding disorder. The diagnosis of hyperfibrinolytic bleeding disorders would improve patient care as effective treatment with antifibrinolytic agents is available. |
| first_indexed | 2024-03-12T10:56:20Z |
| format | Article |
| id | doaj.art-49748d06c7224f5082b932d5626bbae1 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T10:56:20Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-49748d06c7224f5082b932d5626bbae12023-09-02T06:13:54ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792021-05-0154n/an/a10.1002/rth2.12511Fibrinolysis and bleeding of unknown causeDino Mehic0Ingrid Pabinger1Cihan Ay2Johanna Gebhart3Clinical Division of Hematology and Hemostaseology Department of Medicine I Medical University of Vienna Vienna AustriaClinical Division of Hematology and Hemostaseology Department of Medicine I Medical University of Vienna Vienna AustriaClinical Division of Hematology and Hemostaseology Department of Medicine I Medical University of Vienna Vienna AustriaClinical Division of Hematology and Hemostaseology Department of Medicine I Medical University of Vienna Vienna AustriaAbstract Patients with bleeding of unknown cause (BUC) present with a variety of mild to moderate bleeding symptoms, but no hemostatic abnormalities can be found. Hyperfibrinolysis is rarely evaluated as the underlying cause for bleeding in clinical practice, and well‐established global assays for abnormal fibrinolysis are lacking. Few patients with definitive fibrinolytic disorders, including α2‐antiplasmin deficiency, plasminogen activator inhibitor 1 deficiency, or Quebec platelet disorder, have been reported. This review aims to summarize data on established fibrinolytic disorders and to discuss assessments of fibrinolysis in prior bleeding cohorts. Furthermore, we review available global tests with the potential to measure fibrinolysis, such as turbidity fibrin clot assays and rotational thromboelastometry, and their relevance in the workup of patients with BUC. We conclude that, due to the lack of adequate global tests, hyperfibrinolysis might be an underdiagnosed cause for a bleeding disorder. The diagnosis of hyperfibrinolytic bleeding disorders would improve patient care as effective treatment with antifibrinolytic agents is available.https://doi.org/10.1002/rth2.12511bleedingblood coagulations disordersfibrinolysisplasminogen activatorsplasminogen inactivators |
| spellingShingle | Dino Mehic Ingrid Pabinger Cihan Ay Johanna Gebhart Fibrinolysis and bleeding of unknown cause Research and Practice in Thrombosis and Haemostasis bleeding blood coagulations disorders fibrinolysis plasminogen activators plasminogen inactivators |
| title | Fibrinolysis and bleeding of unknown cause |
| title_full | Fibrinolysis and bleeding of unknown cause |
| title_fullStr | Fibrinolysis and bleeding of unknown cause |
| title_full_unstemmed | Fibrinolysis and bleeding of unknown cause |
| title_short | Fibrinolysis and bleeding of unknown cause |
| title_sort | fibrinolysis and bleeding of unknown cause |
| topic | bleeding blood coagulations disorders fibrinolysis plasminogen activators plasminogen inactivators |
| url | https://doi.org/10.1002/rth2.12511 |
| work_keys_str_mv | AT dinomehic fibrinolysisandbleedingofunknowncause AT ingridpabinger fibrinolysisandbleedingofunknowncause AT cihanay fibrinolysisandbleedingofunknowncause AT johannagebhart fibrinolysisandbleedingofunknowncause |