Hyperfibrinolysis: A Crucial Phenotypic Abnormality of Posttraumatic Fibrinolytic Dysfunction

Authors

• Kyosuke Takahashi
• Kazuma Yamakawa
• Anaar E Siletz
• Morihiro Katsura
• John B Holcomb
• Charles E Wade
• Jessica C Cardenas
• Erin E Fox
• Morgan Schellenberg
• Matthew Martin
• Kenji Inaba
• Kazuhide Matsushima

Language

English

Publication Date

10-1-2024

Journal

Research and Practice in Thrombosis and Haemostasis

DOI

10.1016/j.rpth.2024.102568

PMID

39430866

PMCID

PMC11488401

PubMedCentral® Posted Date

9-11-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Traumatic fibrinolytic dysfunction is often categorized into 3 phenotypes based on the result of thromboelastography (TEG) lysis at 30 minutes (LY30): fibrinolysis shutdown, physiologic fibrinolysis, and hyperfibrinolysis. However, the molecular pathophysiology of fibrinolytic dysfunction and the association with clinical outcomes have not been fully evaluated.

Objectives: To assess whether posttraumatic fibrinolysis phenotypes identified by TEG correlate with levels of key fibrinolysis-related serum markers and with risk of mortality and hospital complications.

Methods: This is a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Patients were stratified according to the degree of fibrinolysis upon arrival using TEG LY30 values: low LY30, < 0.8%; normal LY30, 0.81% to 0.9%; and high LY30, ≥3%. Serial values of molecular markers (0-72 hours after admission) and clinical outcomes were compared between fibrinolysis groups.

Results: A total of 547 patients were included (low LY30, 320; normal LY30, 108; high LY30, 119). The high LY30 group had higher tissue plasminogen activator and plasmin-antiplasmin values upon hospital arrival than the low LY30 or normal LY30 groups (P < .001, respectively). There was no significant difference in levels of tissue plasminogen activator, plasmin-antiplasmin, and plasminogen activator inhibitor 1 between the low LY30 and normal LY30 groups. The high LY30 group was associated with an increased risk of 24-hour and 30-day mortality, while there was no significant difference in mortality between the low LY30 and normal LY30 groups.

Conclusion: Our results suggest that hyperfibrinolysis is the most common form of traumatic fibrinolytic dysfunction and is associated with worse outcome.

Keywords

blood transfusion, hyperfibrinolysis, outcome, thromboelastography, trauma-induced coagulopathy

Published Open-Access

yes

Recommended Citation

Takahashi, Kyosuke; Yamakawa, Kazuma; Siletz, Anaar E; et al., "Hyperfibrinolysis: A Crucial Phenotypic Abnormality of Posttraumatic Fibrinolytic Dysfunction" (2024). Faculty, Staff and Student Publications. 4504.
https://digitalcommons.library.tmc.edu/uthmed_docs/4504